Events & Conferences

Staffing in healthcare is such a complex topic that a proposal to limit the number of patients assigned to nurses was recently included on the Massachusetts ballot. The proposal was ultimately defeated, but at least it started a dialogue about the needs of patient populations and addressing staffing in healthcare.

The defeat of the Nurse Staffing Proposal in Massachusetts was welcomed by several industry bodies - not least the American Nursing Association (ANA), who issued a statement saying the one size fits all proposal failed to acknowledge the complexities of nurse staffing. The ANA said it would work with hospital leaders and the unions that brought the initiative to “identify a constructive path forward to develop shared solutions”.

To the casual observer, it might appear unusual that an organization dedicated to protecting the nursing profession is opposed to fixed patient-to-nurse ratios. However, the ANA is keen to point out there is a distinct difference between scheduling (predetermining a set number of nurses based on historical numbers and anticipated volumes) and staffing - which rarely looks beyond the next 24 hours to ensure the right nurses are in the right place at the right time.

Why is Staffing in Healthcare Such a Complex Topic?

Discussing the complexity of staffing in healthcare, the ANA states “appropriate nurse staffing …is achieved by dynamic, multifaceted decision making processes that must take into account a wide range of variables.” Addressing staffing in healthcare is made more complex by up to three staffing models being used simultaneously in healthcare facilities:

• The budget-based model, in which nursing staff are allocated according to nursing hours per patient day.
• The patient-to-nurse ratio model - which can be mandated by state law universally or for specific units.
• The patient acuity model, in which the needs of patient populations determine each shift's staffing requirement.

The patient acuity model is the most dynamic. Not all patients with the same disease or injury have the same needs, and factors such as the severity of an illness and the patient's ability to provide self-care can change staffing requirements at short notice. Further complexities exist during and after an emergency incident - such as a severe weather event - when the number of patients and the nature of their illnesses and injuries can vary dramatically.

Software Solutions for Addressing Staffing in Healthcare

Software solutions for addressing staffing in healthcare already exist. Typically these consist of mass notification systems that have geo-poll capabilities. Geo-polls work by sending a message to a database of contacts in the format of a question with a selection of answers. In the context of addressing staffing in healthcare, the Q&A may look like this:

Q: Looking to cover two early RN shifts in the Oncology Unit. Are you available?
A1: Yes
A2: No

Nursing staff receive the message on their mobile devices by SMS text, voice broadcast, and email. They respond by pressing keys on the keypad (no apps are required), and their answers are sent back to the web-based notification console. Once the required number of shifts has been filled, the poll automatically closes so that nursing staff are aware the shifts have been covered and unit managers are not spending time dealing with unnecessary responses.

One of the benefits of geo-polls is that personnel databases can be segmented by role, location, or other attribute. Consequently, if a unit manager required two RNs, the geo-poll could be send to only RNs and not the entire personnel database. This has benefits in all nature of notification events, such as severe weather blocking roads in certain locations, evacuation orders being sent to all on-site personnel, and checking on the wellbeing of nursing staff working in the community.

5 Best Practices for Addressing Staffing in Healthcare

Maximizing the benefit of a mass notification tool with geo-poll capabilities involves five best practices unit managers should employ - whether the solution is used exclusively for addressing staffing in healthcare or integrated into the communications element of an Emergency Preparedness Plan. These best practices can accelerate the speed at which polls and emergency notifications are sent, and the speed with which responses are received.

1. Prepare Templates for Different Situations

Staffing requirements will undoubtedly change with every vacant shift, but it can help to have templates already created to save time writing new messages every time there is a staffing shortage. Templates are essential if a healthcare facility is intending to use the notification tool to alert personnel to emergencies so they are clearly written at a time when managers will not be stressed or in danger.

2. Plan Reactions to Different Responses

Managers need to plan ahead for the different responses they receive. What if there are not sufficient positive responses to fill vacant shifts? What if personnel need assistance getting to a healthcare facility during a severe weather event? What if a message checking on the wellbeing of a community nurse goes unanswered? There needs to be a contingency plan for every use of a geo-poll message.

3. Explain the Importance of Replying

It can sometimes be sufficient to notify personnel they will be receiving geo-polls, wellness checks, and/or emergency notifications via their mobile devices, but it is advisable to educate nurses on the importance of replying to a message of any nature, even if they are unable to fill a shift, are safe in the community or are unaffected by the emergency in order to save time with follow-up messages.

4. Practice Dry Runs for Multiple Scenarios

Practicing dry runs for all the scenarios in which the geo-poll capability will be used will familiarize unit managers with using the notification portal and nursing personnel with receiving messages on their mobile devices and responding to them. A secondary best practice in this section is to have nursing personnel assign different ringtones for incoming messages to mitigate the risk of alert fatigue.

5. Keep the Personnel Database Up-to-Date

It is essential that personnel databases are kept up-to-date to avoid scenarios in which personnel are not reachable. Ongoing freshness checks with HR databases can ensure only current nursing staff are on the polling and notification lists, while nursing personnel should also ensure they advise HR of any changes to their mobile device numbers. Forgetting to do so could cost them their lives.

Find Out More about Polling for Addressing Staffing in Healthcare

The most important responsibility for healthcare facilities is maintaining a continuity of operations every day, especially during a public health emergency or a disaster. Having adequate nursing personnel during and after these events is critical to meet increased medical demands, yet many organizations struggle with addressing staffing in healthcare - while software solutions that can help overcome this issue quickly and cost-effectively.

Businesses are becoming increasingly aware of the risks faced by traveling workers and are providing a mobile worker safety solution. However, not all solutions are equally as effective at protecting traveling workers from the risks they may encounter, or for best ensuring their safety while in transit.

There are traveling workers (or “mobile workers”) in practically every industry - from computer technicians who travel from client to client, to realtors who show homebuyers around prospective properties. Regardless of which industry they work in, mobile workers are exposed to health and safety risks that do not exist in a static environment.

In some states, occupational safety legislation exist that require businesses to consider the health and safety of mobile workers. Some insurance plans offer discounts when businesses provide a mobile worker safety solution. But often, these solutions are not fully effective at ensuring their safety or providing a rapid response when necessary.

Mobile Worker Risks that Do Not Exist in a Static Environment

The risks faced by mobile workers can vary according to whether they travel short distances domestically, or travel vast distances overseas; but they generally fall into four categories: the public, the environment, slips, trips and falls, and other accidents or illnesses.

Public

The public category contains some of the most dangerous threats to mobile worker safety - especially for mobile workers with disabilities, or mobile workers carrying cash, high value goods, or medical supplies as part of their work. These workers can be subject to theft, assault, unprovoked attack, or simply being in the wrong place at the wrong time in the event of a terrorist attack or shooting incident.

Environment

The environment category includes severe weather events, hostile animals, and dangerous or unhygienic conditions. These threats can be exacerbated when a mobile worker is traveling or working in an environment they are unfamiliar with, or when the nature of the risk is beyond any training they have received. In these circumstances, an effective mobile worker safety solution is essential.

Slips, Trips, and Falls

According to OSHA, slips, trips, and falls account for the majority of general industry accidents and are the second leading cause of all accidental deaths behind motor vehicle accidents. When an employee slips, trips, or falls, in a static workplace, there is usually a colleague to help them or call for assistance. Mobile workers often work alone and have to seek help independently - if they are able to.

Other Accidents or Illnesses

The category of other accidents or illnesses covers any type of in-transit event (including motor vehicle accidents) and illnesses that a mobile worker may not initially acknowledge as an illness until it develops into something more serious. This can be a life-threatening issue if it happens overseas, in a remote area with limited medical coverage, or if the mobile worker is working alone in an unfamiliar environment.

What to Look for in a Mobile Worker Safety Solution

A reliable and effective mobile worker safety solution ideally would be a personal safety app that connects mobile workers with their security team and 9-1-1 when an emergency occurs. In addition to a call directory for easy-to-find assistance and a content portal for on-the-go resources, the app contains two key features to enhance mobile worker safety.

The first is a safety timer that mobile workers can set as they leave to visit a client. The safety timer records the departure point and the destination point, and counts down to zero while the mobile worker is traveling. If the timer reaches zero and is not deactivated by the mobile worker, an alert is sent to the business, which can then be followed up by 9-1-1 or by colleagues in the area.

The second feature is geo-targeted push notifications. Businesses can use this feature to “check in” with a mobile worker periodically, or to send alerts relating to severe weather, travel disruption, or other dangerous event (i.e. active shooter event). Due to the app's geo-tagged location tracking software, if a mobile worker does not respond to the push notification, businesses know where to send help.

Ultimately, Health and Safety officials, emergency preparedness managers, and HR directors should look for a personal safety app that would enable their mobile workers to stay connected with their organization's safety and security personnel and empower them to prioritize their personal safety while at work. 

Phishing is the primary method for distributing malware, viruses, and ransomware, and for conducting Business Email Compromise (BEC) attacks. Depending on whose research you read (and considering many phishing attacks are unreported), the average cost of a successful phishing attack can be anything from three million to ten million dollars for a large company.

The difficulty in defending against phishing attacks is that phishing emails are designed to appeal to employees' senses of fear, sympathy, curiosity, or greed. Different employees are susceptible to different emotions and, due to most phishing emails demanding urgent action, the consequences of an acted-upon phishing email usually manifest quickly - making it difficult to mitigate their effect.

The Two Main Types of Phishing Email

The two main types of phishing email are scatter phishing and spear phishing - scatter phishing being when the same scam emails are distributed widely, whereas spear phishing emails are targeted at one specific individual. Of the two types, scatter phishing is easier to detect because multiple employees are unlikely to have the same triggers that make them susceptible to phishing and - hopefully - an employee will report the phishing attack to the company's IT Security Team.

The second type - spear phishing - is harder to detect because phishing emails are sent individually and crafted to appeal to an employee's specific emotional triggers. This is often achieved through “social engineering” - the practice of researching an individual through their social media accounts or other publicly-available data to guesstimate how they will respond to fear, sympathy, curiosity, or greed. The consequences either type of phishing attack can be devastating, but they can also be mitigated.

Mitigating the Consequences of a Phishing Attack

Based on the above descriptions of phishing emails, there are four possible scenarios:

• A scatter email is detected and reported to IT.
• A scatter email is opened, acted upon, and then reported to IT.
• A spear phishing email is detected and reported to IT.
• A spear phishing email is opened, acted upon, and then reported to IT.

Regardless of the whether an email has been opened and acted upon or not, it is important for all employees to be made aware quickly that the company is being targeted by cybercriminals. If a scatter email has evaded detection by network security defenses, employees need to know who it purports to come from so they can quarantine it as soon as it arrives in their inboxes. If one has been opened and acted upon in error, fast action could prevent the consequences being exacerbated.

If a cybercriminal has taken control of an employee's email account - either through scatter phishing or spear phishing - this information needs to be shared immediately to prevent other employees opening emails from the compromised account. The compromised account should also be taken offline in order to prevent emails from a supposed “trusted sender” being delivered to third party businesses - which could then cause reputational damage if “trusted” emails are opened and acted upon.

The Fastest Way to Alert Employees to a Phishing Attack

The fastest way to alert employees to a phishing attack is through mass SMS texting. An alert sent simultaneously to every employee's mobile device will undoubtedly attract attention - even if individual employees have their mobile devices switched to silent - and will result in employees taking notice of the alert's warning. The text should not only advise employees to quarantine the phishing emails that have been detected, but also warn them about opening any emails and acting upon them.

Sometimes covering all the information necessary in one SMS text is difficult due to the number of characters allowed in a single text alert. Therefore, a more suitable solution is a mass notification platform that can be used to send character-limited alerts to employees via SMS text and more detailed information via email. This would also prompt employees to review their inboxes in order to identify further suspicious emails that should be reported to the company's IT Security Team.

Using Mass Notification to Conduct Phishing Simulation Exercises

One of the best ways to defend networks against phishing emails is to condition employees against phishing via simulation exercises. In these exercises, employees are sent fake phishing emails to see whether they are detected or not. The fake emails are then followed up by an alert poll to find out who detected the emails were fake and how they reacted to them. A typical Q&A alert poll might consist of the following options for employees to select an answer:

Q: Did you receive an email entitled “Your Account Subscription” from ABC Enterprises?

A1: No.

A2: Yes, and it didn't apply to me so I deleted it.

A3: Yes, and I thought it was a scam so I quarantined it.

A4: Yes, I opened it and then reported it.

A5: Yes, I opened it and clicked on the link but nothing happened.

The feedback from this type of phishing simulation exercise will give companies a better understanding of which employees are susceptible to phishing emails and how they are likely to react to them. The exercise should be repeated at irregular intervals to test employees' susceptibility to different emotional triggers, as one exercise alone may not prove to be effective. Once the feedback from several exercises has been analyzed, companies will be able to address areas where they are most at risk from phishing.

According to the Center for Disease Control, one in every four women and one in every ten men will experience domestic violence in their lifetime. Physical and mental abuse at the hands of an intimate partner affects every aspect of the victim’s life, including the ability to work. According to Legal Momentum, victims of domestic violence lose about 137 hours of work per year, and causes victims to lose the equivalent of 32,000 full-time jobs per year. The Department of Labor reports similar statistics, with victims losing 8 million hours of work per year.

The pervasiveness of domestic violence in the United States means that employers, human resource officers, and workplace safety manager have a responsibility to help victims. According to the Society for Human Resource Management, 65% of companies do not have formal workplace violence prevention policy. The survey also found that only 20% of companies offered a training on domestic violence. There are many ways that employers can do better to protect employees who may be struggling with domestic or partner violence in the workplace or in their personal lives.

Given the prevalence of this issue, it’s important to have an employee policy that provides protections for victims of domestic violence. These include mandates that would keep employees safe at work, keep their job, help them get time off to go to court or recover from injuries sustained from domestic abuse. If these rules are written into the employee manual, it can be a resource for anyone who might be struggling. It’s also important to post these policies in the workplace, and make human resources available to employees who might be struggling with a difficult situation. In many instances, employees might be concerned about work performance or losing their jobs, which can be mitigated by keeping lines of communication open.

How to Address Domestic Violence in the Workplace

The first step to addressing domestic violence in the workplace is to acknowledge the issue. While employers may not believe that domestic violence can impact the workplace, the issue does not have bounds. For victims, the violence can impact every element of their life. Once a company realizes that the workplace has a responsibility to address this issue, it might worry managers that the infrastructure is not equipped to handle issues of this kind.

In an interview with SHRM, Kim Wells, executive director of the Corporate Alliance to End Partner Violence said that employers don’t have to be experts to help. “Once employers understand that domestic violence can impact their workplace, their next fear is that they’re not equipped to address the issue. And that’s true, but they’re not expected to be experts,” Wells said. “While we want managers and supervisors and co-workers to be trained about domestic violence and its impact on the workplace, and how to respond and get people to the help they need, we do not want them to take on a role that should be filled by those professionally trained to help.”

Once a company has decided what role to take on in addressing domestic violence, they can craft a response program that hires professional help for employees who are victims. A well crafted response plan will include several steps that accommodate employees who are victims, whether it is addressing a workplace issue or providing support. These plans don't mean that human resource steams need to directly tackle these issues, but rather provide the correct tools and guidance to keep employees safe.

Leveraging Technology to Help Domestic Violence Victims 

While managers might be reluctant to discuss something that affects people’s personal lives, it's crucial for company safety to include a protocol for domestic violence situations. Technology can play a major role in helping HR provide outreach and help for victims, beginning with an anonymous 2-way tip texting system. This tool allows employees to communicate safety concerns, whether it involves workplace violence or violence experienced outside the office, without compromising their own safety. If a fellow employee is concerned for a coworkers safety, this also provides an avenue to help this person get help without jeopardizing the workplace relationship. In many of these scenarios, victims are especially likely to be hesitant to reach out, and a two-way tip texting tool can be an important communication solution for safety managers. 

If an employee is not able to manage their safety outside of the office, there is a risk that the violence in the home can be brought into the workplace. If an abusive spouse or significant other enters a workplace, a workplace safety app allows employees to either contact 9-1-1 directly or alert safety managers so that they may respond to the incident accordingly.  This way, local law enforcement can arrive on the scene faster with the correct information about the threat. Not only will the workplace be better equipped to protect the employee experiencing domestic violence, it will also improve the safety of the company community as a whole. 

There is no denying that severe weather events are increasing both in number and in the damage they cause; and that emergency managers are placed under significant stress. If you’re attending the National Healthcare Coalition Preparedness Conference in New Orleans later on this month, stop by booth # 5 to talk about preparedness.

Not only do healthcare facilities have the responsibility for the safety of patients in their care and staff when storms, hurricanes, and tornadoes land, they may also have to cope with a large influx of patients who have sustained weather-related injuries. Similarly, community emergency managers have the responsibility of making sure vulnerable citizens are also safe, especially if they can’t evacuate by themselves.

Thereafter, there is what is known as the “ripple effect” - an increase in hospital admissions attributable to the exacerbation of chronic diseases caused by medications being left behind during the rush to evacuate, a loss of power to operate home medical devices such as ventilators, or the closure of pharmacies. The ripple effect can be responsible for as many hospital admissions as weather-related injuries, and can last for months after a severe weather event due to longer hospital stays.

How do Communities Prepare their Healthcare Facilities for Severe Weather Events?

All healthcare facilities participating in the Medicare and Medicaid programs are required by law to have an all-hazards Emergency Preparedness Plan - along with a Communications Plan - and policies and procedures for testing and executing the plan. It is also necessary for healthcare facilities accredited by the Joint Commission to have an all-hazards Emergency Operations Plan that covers communications, resources and assets, safety and security, staff responsibilities, utilities, and clinical support activities.

The term “all-hazards” is not defined in either the CMS' Emergency Preparedness Rule or the Joint Commission's accreditation guidelines, and it is left to each healthcare facility to conduct a risk assessment to determine what hazards it may be subject to and susceptible to. Consequently there is no “one-size-fits-all” methodology for preparing for severe weather events, or indeed for any particular type of emergency (fire, active shooter, hazardous material incident, etc.).

Do Emergency Preparedness Perceptions Differ from Reality?

That would appear to be the case according to our “Emergency Preparedness and Security Trends in Healthcare Report” in which we surveyed hundreds of healthcare leaders about their perceived safety concerns and the actual events that have taken place at their facilities over the past two years. Although severe weather events ranked high in both the safety concerns and actual events categories, this did not reflect in the frequency with which severe weather emergency plans are tested.

A likely reason for this is that CMS and the Joint Commission require healthcare facilities to conduct at least two emergency preparedness exercises per year, while most state fire codes require healthcare facilities to conduct a minimum of two (and sometimes four) fire drills each year. Therefore, provided fires are included as a potential hazard in a healthcare facility's risk assessment, the healthcare facility is fulfilling its Emergency Preparedness requirements by conducting state-mandated fire drills.

Resolving Communication Issues is Key to Preparedness

Healthcare Facilities

When an emergency incident occurs, speed is of the essence. A minute's delay in alerting staff to the risk of danger can cost lives. Similarly, when staff, medication, and supplies are in short supply, healthcare leaders need fast information about where the shortages exist and how soon replacement staff, medication, and supplies can be organized. If communication issues exist in any of these areas, the consequences could be significant for both staff and patients.

A mass notification platform is an ideal solution for resolving potential communication issues. It not only provides a means of simultaneously alerting staff to the risk of danger via multiple channels of communication, but supports two-way communication to enhance situational awareness, has a geo-poll capability to facilitate quick answers to critical questions, and allows the segmentation of contacts according to role, location, or other attribute.

• By alerting staff to a severe weather event via multiple channels of communication, the reach of the alert is extended to the maximum possible.
• Two-way communication ensures hospital administrators are kept up-to-date with all the information they need to effectively manage the emergency via one portal.
• Geo-polls provide the opportunity to quickly obtain information about staff availability, the accessibility of medication and supplies, and capacity in other healthcare facilities.
• The segmentation of contacts enables hospital administrators to alert only those for whom incidents are relevant, thus minimizing disruption in the rest of the healthcare facility.

Overall Community Preparedness

Another critical component to overall community preparedness is ensuring that anyone with vulnerable needs and without access to a healthcare facility is accounted for and is provided resources. Maintaining an online vulnerable needs registry is one way to identify community members who might need assistance during a severe weather event. This would help emergency members make sure that the right resources are in the right place to help the right people at the right time, including coordinating with healthcare facilities.

Let's Continue the Conversation

Meet us at booth # 5 at the National Healthcare Coalition Preparedness Conference in New Orleans and let's continue discussing how to prepare our healthcare facilities and communities for severe weather events. Take a look at the findings from our latest survey on healthcare preparedness trends and let us know what you think.

Every year, between 5 and 20 percent of the population gets the flu. For businesses, losing between 5 percent and 20 percent of a workforce for an average of three days is expensive, making the need to communicate outbreaks critical. The U.S. Department of Labor has estimated the annual cost of flu-related absenteeism to be nearly $20 billion; but absenteeism may not be the biggest flu-related problem businesses have to manage.

A potentially bigger problem is “presenteeism” - employees turning up for work with the flu, and consequently underperforming while sharing the infection with work colleagues. Not only does this increase the rate of flu-related absenteeism throughout the business, but employees turning up for work when they are ill generally take longer to recover and often end up taking time off anyway.

Where presenteeism can be become a serious problem is when flu infections spread to employees with a high risk of complications. The high-risk group includes older employees, pregnant employees, and employees with medical conditions such as asthma, diabetes, and metabolic disorders. If high-risk employees contract the flu, and then develop complications, the outcome can be fatal.

Best Practices for Preventing Flu Outbreaks in the Workplace

The best practices for preventing flu outbreaks in the workplace include encouraging flu vaccinations, maintaining good air quality in the office environment, and discouraging employees from turning up to work when they feel unwell. In order to support the third of these best practices, businesses should develop policies relating to sick leave, the transfer of duties, and what to do if feeling unwell while traveling to the workplace - and distribute these policies to all employees.

When an employee arrives at the workplace displaying symptoms of flu - or develops the symptoms of flu while working - they should be sent home. However, removing an infected employee from the environment may not necessarily prevent a flu outbreak. Flu particles can remain suspended in the air for up to an hour (which is why maintaining good air quality is so important) and, in droplet form (i.e. from sneezes and coughs over desks and office furniture), can remain active for up to three hours.

Naturally, after an employee has been sent home due to displaying symptoms of flu, their immediate environment should be sanitized. However, without knowing the employee's exact movements since their arrival, flu particles may still remain in the air or in droplet form on office furniture - presenting a risk that work colleagues might still become infected. This is of particular concern when employees with a high-risk of complications are in danger of contracting the flu.

Alerting Employees to Outbreaks of Flu in the Workplace

Whereas email may be an appropriate channel of communication for distributing information about flu vaccinations and flu-related HR policies, it is not ideal for alerting employees to short-term dangers. The threat from flu droplets may have completely receded before an employee reads their emails, by which time it may be too late for the employee to avoid exposure to the infection. Consequently a better solution than email is required for alerting employees to outbreaks of flu in the workplace.

One such solution is a mass notification platform that can alert thousands of employees simultaneously to the risk of danger using multiple channels of communication (SMS text, social media, voice broadcast, etc.). It is an ideal solution for alerting employees to outbreaks of flu in the workplace quickly, as it only takes a few clicks of a mouse to advise employees to keep clear of a potentially infected area, and then inform them when it should be safe to enter the area again.

Using a mass notification system in this manner is also a good way of publicizing that a “send home” policy is being enforced. It will help further discourage employees from turning up from work when they feel unwell - not just when they are suffering from flu, but from all illnesses - thus reducing presenteeism and the costs associated with it. 

On November 6th, citizens of Massachusetts will vote on a nurse staffing proposal limiting the number of patients assigned to a nurse depending on the type of patient and the patient's condition. Supporters of the proposal claim it will increase safety and improve patient outcomes. Opponents disagree.

In 2017, the Massachusetts Nurses Association created a ballot campaign committee - the Committee to Ensure Safe Patient Care - with the objective of setting a limit to the number of patients assigned to one nurse at a time. The Association claims unsafe patient assignments in healthcare facilities are responsible for higher rates of readmission, medication errors, and patient deaths, and is campaigning in favor of a Patient Safety Act (PDF) that would enforce patient limits throughout the state.

The Association is supporting its campaign for safe patient assignments with the results of a survey conducted earlier this year among nurses registered with the Massachusetts Board of Registration in Nursing. The survey - “The State of Patient Care” - reveals that patient safety concerns among nurses (fewer than half of which were members of the Association) have increased significantly compared to a similar survey conducted in 2014. Among some of the key statistics reported include:

• 64% of respondents reported an incident of patient injury due to unsafe patient assignments - up from 46% in 2014.
• 77% of respondents reported a patient medication error attributable to understaffing - up from 57% in 2014.
• 66% of respondents reported patients were staying longer in hospitals (from 51%), while 72% reported an increased number of re-admissions (from 56%).
• The increased number of re-admissions (according to 86% of respondents) is due to nurses not having the time to educate patients and provide adequate discharge planning.
• 77% of Massachusetts nurses said they were assigned too many patients to care for at one time, while 36% reported patient deaths directly attributable to understaffing.

This is not the first time the Massachusetts Nurses Association has campaigned for limits to be applied to patient assignments. In 2014, the Association campaigned for a similar proposal, but agreed to withdraw its campaign after a compromise was reached setting a two-patient limit for nurses in intensive care units. This time around, there has been no compromise agreement, and opponents of the nurse staffing proposal are campaigning fiercely to have the proposal defeated at the polls.

What Don't Opponents Like about the Patient Safety Act

Opponents to the nurse staffing proposal include the Massachusetts Health and Hospital Association, the Organization of Nurse Leaders (representing nurses now working in healthcare management), and ANA Massachusetts - the state chapter of the American Nurses Association. Under the banner of the Coalition to Protect Patient Safety, these organizations argue that the blanket proposal is too rigid and expensive, and could even force some smaller hospitals to close.

The coalition of opponents claim there is already a nursing shortage in Massachusetts and that the requirement to hire more nurses to cope with the new assignment limits will result in less experienced nurses caring for patients - which will make patients less safe. The coalition also claims the nurse staffing proposal will result in longer waiting times, and budget cuts in other areas of healthcare operations in order to comply with the Patient Safety Act.

To support its opposition to the nurse staffing proposal, the Massachusetts Health and Hospital Association commissioned a study which found that mandated patient assignment limits will cost the healthcare system $1.3 billion in the first year and $900 million each year after that. The Massachusetts Nursing Association disputes there is a nursing shortage in Massachusetts and argues that the cost to the healthcare system will decrease as the quality of care improves.

However, Nancy Gaden - the Chief Nursing Officer at Boston Medical Center - estimates that, if passed, the nurse staffing proposal will result in sixty-two bed closures, a decrease in capacity of the emergency department of more than one hundred patients, and eight hundred fewer childbirths at the medical center each year. She also claims the costs associated with complying with the Patient Safety Act would lead to major cuts in the medical center's community health program.

So, Who's Right and Who's Wrong?

There is no doubt there is a national shortage of nurses, and the US Bureau of Labor Statistics predicts 1.1 million additional nurses are needed by 2022 to avoid a further shortage due to retirements, burnout, and nurses leaving the profession because of the increasing rates of violence in the healthcare industry. However, those in favor of the nurse staffing proposal claim there is an oversupply of nurses in the Bay State due to Massachusetts' nursing schools graduating 3,500 nurses each year.

With regard to the cost of hiring additional nurses to comply with the patient assignment limits, an independent analysis was conducted by the Massachusetts Health Policy Commission (PDF). The Commission determined healthcare facilities would need to hire between 2,286 and 3,101 additional nurses to meet the ratio requirements at a cost of between $676 million and $949 million, and noted that Massachusetts already had a higher-than-national-average nurse-to-patient ratio.

The Commission also conducted a comparison between the proposed initiative and the situation in California - the only other jurisdiction to have state-mandated patient assignment limits. Although not an apples-for-apples comparison due to differences in the scope of Californian law and the proposed Patient Safety Act in Massachusetts, the Commission's four key takeaways from the comparison were:

1. There was a significant increase in nurse staffing in California hospitals post-implementation of ratios.
2. There was a moderate effect on Registered Nurses´ wages post-implementation of ratios.
3. There was no systematic improvement in patient outcomes post-implementation of ratios.
4. There has been no comprehensive, retrospective analysis of implementation costs.

The Good, the Bad, and the Solution

Regardless of who's right and who's wrong, the outcome of November's vote will have implications for both sides of the argument. If Massachusetts' citizens vote in favor of the nurse staffing proposal, nurses will be less likely to suffer from workplace burnout and violence, while the healthcare industry will have to find the funds to pay for increased staffing costs. If the vote goes against the initiative, the fact the proposal was brought to a vote will raise the profile of the problem, while failing to resolve it.

A potential solution to either outcome is a Geo-Poll tool for shift management. This tool has many valuable uses and, in the context of Massachusetts' nurse staffing proposal; it can be used to ensure safe nursing levels are maintained without healthcare facilities having to divert funds from other critical healthcare operations. The concept behind the Geo-Poll tool is simple, and it is easy for nursing administrators to use. Whenever a shift is understaffed - or forecast to be understaffed - nursing administrators send a single message simultaneously to all the nurses suitable for covering the shift. The message is in the form of a poll, asking a simple question with a choice of answers. An example would look like this:

Q. Looking to cover two early shifts in the Oncology Unit. Are you available?
A1. Yes
A2. No

Messages are delivered to nurses' mobile devices by email, SMS text, and voice broadcast. Emails contain a link the recipient clicks to answer the question, while responses to SMS texts and voice broadcasts are controlled by the keypad on the mobile device. The poll has an auto-close feature, so as soon as the nursing administrator has received (in this case) two positive responses, the poll closes - thus avoiding confusion and the scenario in which nurses re-arrange other commitments unnecessarily.

The Secondary Benefits of a Geo-Poll Tool

As we discovered in our recent survey of “Emergency Preparedness and Security Trends in Healthcare”, a communications gap in healthcare facilities exists that can result in emergency messages not getting through to the right people at the right time - potentially placing staff in danger. Our survey also found that perceived safety concerns in the healthcare industry do not necessarily reflect day-to-day reality, and consequently there is a lack of coordination when events occur that staff are ill-prepared for. Sign up for our webinar on October 25th to not only access the survey results, but also hear from healthcare industry experts discussing hot topics in emergency preparedness.

As well as being able to resolve understaffing issues quickly and inexpensively, a Geo-Poll tool is a go-to solution for other vital communications. The Geo-Poll tool can be used to notify staff of events affecting healthcare facility operations and provide information of ways to overcome these events. Although it is not necessary to send the messages in a Q&A format, by requesting a response, nursing administrators can ensure the messages are reaching their intended recipients.

This solution makes healthcare facilities safer and more secure, and can be managed from any Internet-connected device - meaning it is not necessary for a nursing administrator to be physically present at a hospital in order to resolve understaffing issues or ensure business continuity when an adverse event occurs. You can find out more about the nature of the adverse events we found by downloading our survey here.

A recent survey reveals that there might be a disconnect between how healthcare preparedness planning efforts are implemented and the reality of actual incidents occurred.

On Thursday, October 25th, a webinar called "Expert Panel: Triaging Healthcare Emergency Preparedness Today" revealed key findings from a recent survey, Emergency Preparedness and Security Trends in Healthcare. The survey polled over 300 healthcare professionals, mostly involved in security, preparedness and safety initiatives. One of the findings that will be covered during the webinar focuses on the biggest safety concerns respondents are dealing with.

"The number-one safety concern plaguing healthcare leaders is weather events." 

Weather events came out as the top safety concern for healthcare leaders, followed by active shooter incidents as a second-leading safety concern. Recent weather catastrophes such as Hurricane Harvey have brought to light the fragility of healthcare institutions, which for the most part, have to remain open and operational during these events. 2017 was particularly hard, with natural disasters estimating to cost the United States approximately $306 billion in damages. Hospitals hit by Hurricane Harvey estimated that natural disaster costs totaled up to $460 million.

Second-Leading Safety Concern: Active Shooters

What's interesting about active shooter incidents being a close second place safety concern is the rarity of these incidents. In fact, according to the latest FBI active shooter statistics, an active shooter is more likely to strike at an area of commerce than in a healthcare facility. 

Other pressing issues such as workplace violence are also covered in the Emergency Preparedness and Security Trends in Healthcare report and while the third leading cause of death for healthcare workers is due to workplace violence, interestingly, it was not considered a top safety concern by survey respondents. 

However, this shouldn't stop healthcare facilities to be prepared for all of these types of incidents. The focus should be on preparedness efforts for not only the seemingly more alarming incidents, but also for incidents that are more likely to occur such as weather events. 

Listen to Our Conversation About Healthcare Emergency Preparedness 

Hear what your colleagues think about the findings and how the healthcare industry can enhance their emergency preparedness initiatives. Our webinar held on October 25th featured emergency managers from Middlesex Hospital and Hartford HealthCare. Listen to the recording and download a copy to the survey report, Emergency Preparedness and Security Trends in Healthcare. 

Employees are busy. Every day, workers tackle projects, attend meetings, work with customers, problem solve, and, of course, receive, read, and send out e-mails. According to the Radicati Group, the average employee sends and receives over 200 e-mails a day. 

There are studies that show employees spend two to six hours a day sending and receiving e-mails each day. Given the influx of e-mails in employee inboxes, it’s not a surprise that employees might overlook important company updates sent by e-mail.

It’s easy for businesses to communicate company updates, weather alerts, building closings and local construction updates via e-mail. However, given the number of e-mails employees field on a daily basis, it’s possible that some may misplace, delete, or not see a message containing crucial company information. In the case of emergency information or important market related e-mails, missed messages can cause the spread of misinformation and rumors. Employees might not check their e-mail outside of work hours, or certain messages might not reach multiple departments. There’s also the matter of remote employees, who might be out of reach of the information. If all employees don’t receive necessary information, there can be major consequences for the business in question, from lost profits to disengaged workers.

In order to keep employees engaged, informed, and safe, businesses should invest in technology for communication. Employers need to consider employees whether they’re in the office, in the field, or traveling, and this means thinking outside the box of e-mail. Technology can help prevent these gaps in communication, especially when it comes to safety and wellness. By leveraging technology, businesses can keep employees informed when it matters most – during an emergency or impending event. Here are some of the ways that businesses can strengthen employee communication with technology.

1. A Clear Signal

Employers should first figure out what type of message they want to get out and how it will resonate with employees. If the message is an emergency update, such as a cyberattack or active assailant, it will require different procedure than a message about a staffing issue or power outage. This is where establishing a clear signal comes in.

A few companies are still relying on phone trees, intercom, or public address systems to contact employees, which are less reliable. Even worse, fewer employers are engaged with these networks. Instead, many are more likely to turn to email, instant messaging, or a social collaboration network to communicate. In general, mass notification systems, intercom or public address systems, company mobile apps and instant message, or social/collaboration apps had greater success at grabbing employee’s attention. However, mass notification systems and company mobile apps are most effective for contacting employees in a fast, reliable manner.

While e-mail can reach 95% of employees, it might only engage 66% of their attention. One example of an instant communication that will more effectively engage your business community is a push notification or alert. Sending out a high-value push notification is an effective way to get employees to engage with a message, but be aware of alert fatigue, which occurs when communication is too frequent.

Before sending out an alert, be sure to follow these guidelines. This will help prevent alert fatigue as well.

• Establish policies about how frequently they send out communications
• Make the language straightforward
• Include current information
• Make directions easy to follow and understand
• Figure out who will get the messages
• Have up-to-date employee contact information

 2. A Safe Workplace

This year, the #MeToo movement brought the issue of workplace violence and harassment to the forefront of the national conversation. The Equal Employment Opportunity Commission found that between 25-85% of women in the workforce will experience sexual harassment in the United States. These alarming stories and statistics demonstrate the need to revisit and bolster workplace safety efforts.

Promoting a safe work environment has many benefits for a business. In addition to the most important goal, promoting a healthy, productive workplace, these efforts will also benefit the company financially. Employers should also consider other forms of workplace violence - including verbal or written threats, physical or verbal harassment, physical assaults and even death. High-risk workers include delivery drivers, healthcare professionals, public service workers, customer service agents, law enforcement personnel and those who work alone or in small groups.

It’s possible that your workplace already has workplace safety procedures, but are these resources being communicated to employees? Half of all respondents in Rave’s Workplace Safety and Preparedness Survey weren’t aware of their company’s emergency plans for workplace violence and active shooter incidents. This is another scenario where communicating policy or resources via a mass notification system can prove valuable.

Technological advances can help businesses support their employees and encourage them to come forward about workplace violence, sexual harassment and other conflicts. Having an emergency call button on hand can improve emergency response in the workplace, giving workers the ability to reach security or law enforcement in case of a situation that may put their safety in danger.

Another valuable tool is anonymous two-way tip texting. Employees are more likely to report suspicious or dangerous behavior if there’s more privacy. Confidential tip texting allows employees to directly communicate with their employer’s security staff or relevant personnel. The two-way messaging feature helps them report any suspicious activity, along with text and images, discreetly through their smartphones. It gives employees an opportunity to report an incident without fear of retaliation and puts safety into their own hands.

3. Put Key Information in a Central Location

In the mobile phone age, employees likely expect information to be immediately and readily available. Businesses can help their employees stay organized and connected through a call directory, which would include important employer contact information. This directory would allow a business to include the phone numbers of human resources, travel, IT and facilities so their employees can reach out to these departments faster and report any issues and concerns. This can be especially valuable if employees are working remotely or are out of office. By putting all the information in an accessible location, it can speed up communication.

A content directory could feature company information in a central location. The directory could post company news, holiday schedules, travel agent contacts and human resources policies and procedures. This directory would also be compatible with a company app, putting all of the resources employees need in a convenient location. By offering the tools employees need in one place, they are more likely to check the app and communication will be improved overall.

To learn more about how technology is helping businesses strengthen their employee communication strategies, download the whitepaper.

It’s hard to believe Rave has been in business for 14 years. As I was reviewing some documents, I happened to notice that Rave’s birthday is quickly approaching. I figured this is a good time to look back at the past 14 years and how we’ve come to where we are.

A Look Back at Rave's History

2004 – Rave was founded. After founding and building a company that leveraged carrier-based location services to helping manage logistics and service companies, three founders see an opportunity in helping better connect Higher Education Institutes with their students. 

2005 – First clients brought on board. Montclair State University and the University of Southern Florida are still Rave Customers.

2006 – Montclair State is recognized by the Jeannie Clery Foundation for its use of Rave Guardian in helping improve student safety.

2007 – Virginia Tech Shooting. This tragic event was a seminal moment is Rave’s history as colleges and universities turn to proven vendors to help them further improve their ability to communicate during emergencies.

2009 – Rave launches Smart911. Within first year of launch 3 documented live saving incidents: heart attack victim, seizure, and allergic reaction. Rave surpasses 100 client mark.  

2010 – Rave is selected as winner of IDG’s 2010 21st Century Achievement Award. 

2011 – Winner IACP Excellence in Technology Award for work in Nashville TN with Smart911. Rave supports clients in all 50 states.

2012 – Rave Surpasses 500 client mark. Arkansas is first to deploy Smart911 statewide. Sandy Hook school shooting prompts Rave to begin working on enhancing communication between 9-1-1, first responders, and school personnel. Hurricane Sandy shows the need for emergency management agencies to better collect and manage information on vulnerable populations, and Rave enhances its Prepare product.

2014 – Rave launches Rave Panic Button after close collaboration with Snohomish County, WA Schools, Newtown, CT and others. Rave offers 9-1-1 centers and public safety agencies tools for better collecting and managing information about facilities in their jurisdictions.

2015 – Rave surpasses 1000 client mark. Rave is awarded is 14th patent.

2017 – Rave surpasses 2000 client mark, with many clients representing hundreds of agencies and/or schools. 20 million active users, and protecting a population of over 50 million. Rave sends 500 million emergency messages, processes approximately 18% of 9-1-1 calls in the country, and is involved in 5000 panic button activations. Rave begins selling products into the enterprise market and acquires two companies expanding its geographic footprint into Canada and also it’s breadth of services available.

2018 – Which brings us to 2018.

By any measure this has been a year of growth and transformation. This year will mark our 10th consecutive year of double digit growth, with the last 3 quarters being the largest in the company’s history. Through strong partnerships we are delivering improved location information on 9-1-1 calls from smart phones, greatly improving the ability of responders to locate and help callers.

Rave Panic Button is now protecting thousands of schools from Washington DC and Long Island NY, to counties in Florida and across the country. Smart911 just launched in the City of Chicago, further growing the list of major metropolitan areas supporting this life saving service. New apps were launched for both Smart911 and Rave Guardian that have been extremely well received and already have thousands of downloads. 

Our annual Rave Summit user group was the largest ever and attended by safety officials from 30 different states. The team is growing rapidly, hiring unbelievably talented folks in all departments.

Finally, most importantly, we continue to hear from our customers about how we are helping them help their constituents. We launched a series of regional events this year to be able to spend more time sitting down with our customers and hearing their use cases and how we can better serve them. It is incredibly motivating and an honor to be able to provide products to an amazing group to clients that are helping to improve safety and ultimately lives.

Although the majority of recent active shooter incidents have occurred in school environments, healthcare facilities also face the threat of an active shooter. Consequently five government agencies have collaborated to produce a guide to the five stages of preparedness for active shooter events in medical environments.

During an active shooter incident, the natural human reaction - even for those who are highly trained - is to be startled and feel fear and anxiety. Healthcare facilities have to be prepared for this natural reaction and incorporate it into their “all hazard” Emergency Operation Plans (EOP).

Due to the unique circumstances of an active shooter incident, the Departments of Health and Human Services, Justice, and Homeland Security - together with the FBI and FEMA - have produced a guide to the five stages of preparedness for active shooter events in medical environments.

The guide - “Incorporating Active Shooter Incident Planning into Healthcare Facility Emergency Operations Plans” (PDF) - is not intended to replace the six Joint Commission’s Emergency Management Standards, but rather to provide advice about how to better prepare for an active shooter incident.

The Five Stages of Preparedness

The five stages of preparedness listed in the guide consist of prevention, protection, mitigation, response, and recovery. Throughout the guide there are examples of how the stages can be built into an EOP - for example:

• Prevention - Regularly changing the codes on doors with keypad access and controlling who has access to the codes.
• Protection - Providing designated safe rooms where staff, patients, and visitors can retreat to when the threat of danger occurs.
• Mitigation - The implementation of an effective communication system to alert internal security and external law enforcement.
• Response - Conducting drills and exercises to best prepare staff for active shooter incidents - ideally with the involvement of law enforcement.
• Recovery - Train staff in psychological first aid in order to restore the treatment/therapeutic environment as soon as possible.

Although none of the five stages is given higher priority over another, the guide stresses that active shooter incidents are unpredictable and evolve quickly. Because of this, the best communication system to implement is one that alerts internal security and external law enforcement simultaneously.

It is also recommended in the guide that emergency responders have advance information on locations where they are likely to find staff, patients and visitors unable to evacuate, and the location of available public address systems, two-way communication systems, security cameras, and alarm controls.

The Importance of Communication in Emergency Preparedness

A recent survey on healthcare emergency preparedness found that 7% of healthcare facilities from across the United States had experienced an active shooter incident within the last two years. While these incidents are still considered rare and are far less in comparison to other industries such as commerce, having a solid communication plan in place that aligns with your EOP is key.

 Courtesy of FBI - Designated Active Shooter Incidents from 2000-2017

One way to ensure communication during an emergency is through an emergency notification system that streamlines and improves hospital or healthcare facility communications throughout your organization. A simple interface sends alerts to all modes — email, voice, PA system, text, social media, and others — from any internet-connected device. As an easy cloud-based service installation, it integrates with your existing systems and infrastructure. 

Some systems can also send out geo-targeted polls. This unique poll-based alerting feature allows you to solicit information and location data from a select group of recipients through SMS text, voice, and email. This might be useful after an active shooter event, to find out the status of employees by simply asking "Are you ok?". Employees can provide a simple “yes” or “no”. This tool helps to humanize business continuity and extends employers’ capabilities to keep their employees safe at all times.

Alert fatigue - desensitization to safety alerts due to their sheer number - is an acknowledged problem in the healthcare industry. It is claimed to be responsible for more than two hundred hospital deaths in five years, but there could be many more deaths if healthcare emergency notifications are unheeded. 

In 2011, the Boston Globe published an article claiming more than two hundred patients had died in the previous five years due to alert fatigue. The article pointed to the increased use of healthcare technology as being responsible for desensitization to safety alerts, and reported that a 15-bed hospital in Baltimore had recorded an average of 942 critical alarms per day - or one alarm every 90 seconds.

A later study conducted at the University of California San Francisco (UCSF) School of Medicine recorded more than two and a half million unique alarms over a 31-day period. Researchers suggested a solution to this problem was to tailor alarm settings to individual patients or specific scenarios; but, because of the many different types of technologies in use, this is impractical.

Why Are There so Many Alerts in Healthcare Environments?

The reason for there being so many alerts in healthcare environments is due to hospitals being incentivized to adopt electronic health records and technology to maintain them. It has been estimated that the number of Computerized Provider Order Entry Systems (CPOEs), smart intravenous infusion pumps, and cardiac monitoring devices in use has increased seven-fold over the past ten years.

Although the digitalization of healthcare has had a generally positive effect on patient safety, the unanticipated consequence of alert fatigue has emerged. This consequence is of particular concern in scenarios where healthcare professionals are struggling to cope with the increasing cognitive load of healthcare environments or when a stressful situation occurs.

What Problems Could Alert Fatigue Cause during an Emergency?

In an emergency, healthcare professionals are subjected to the maximum cognitive load in a stressful situation. They have to execute hospital preparedness plans while their lives - and the lives of their patients - are potentially at risk. Naturally, in this scenario, it would be understandable if an alert was overlooked or unheeded; but what if the emergency notification itself was overlooked or unheeded?

With healthcare professionals being subjected to so many alerts each day, missing or ignoring an emergency notification is not an unrealistic notion. In busy departments, it would be expected that colleagues would identify the notification as an emergency and start auctioning hospital preparedness plans; but in quieter environments the consequences could be devastating.

A Solution to the Missed Emergency Notification Issue

A solution to the missed emergency notification issue is not - as some healthcare organizations have done - to install more electronic alarms or overhead paging systems. Instead, healthcare organizations should be looking at solutions that - as the UCSF study suggested - have tailored alarm settings, and that are unique from any other type of alarm.

Emergency notification systems that use multi-modal communication channels are the obvious solution. These systems can communicate emergency notifications by voice broadcast, SMS text, email, and other media to ensure the broadest reach of any notification system. They also have the advantage of communicating the nature of the emergency and which hospital preparedness plan to action.

With regard to tailored alarm settings, healthcare professionals and other hospital employees should assign a unique ringtone to the emergency notification number - ideally a ringtone that means something to them. Then, whenever an emergency notification is received, the alert will not be overlooked or unheeded due to desensitization.

The Benefits of Rave Alert for Healthcare Organizations

Rave Alert is one of several emergency notification systems on the market that use multi-modal communication channels, but it has a couple of capabilities that make it the most appropriate solution for healthcare organizations. The first is that the system´s database can be segregated by location, role or other attribute. This capability has the benefit of minimizing disruption when an emergency notification is only relevant to employees in a certain area of a healthcare facility.

The second benefit is the geo-poll feature. This feature enables system administrators to send targeted follow-up alerts when necessary - or to inquire if employees are in need of assistance during or after the emergency incident. The feature works by sending a question followed by a choice of answers. For example:

Q: Do you need any assistance regarding the Hospital Preparedness Plan? 

A: No.

A: Yes, send more personnel.

A: Yes, we cannot evacuate.

As the geo-polls are answered, system administrators and incident managers can deploy resources as necessary. If the geo-polls are not answered, incident managers can identify where problems may exist and take further action to investigate and resolve the problems as necessary.

There are significant advantages of integrating an on-call staffing module into an emergency alert system with geo-polling capabilities - especially in the healthcare industry, where on-call medical staff may be required at short notice, and where many medical staff work alone in the community.

Since November 2017, healthcare entities in the Medicare and Medicaid programs have been required to comply with the CMS Emergency Preparedness Rule. The CMS Emergency Preparedness Rule was developed to address gaps identified in past responses to emergency events, establish a consistent framework for all healthcare entities, and encourage coordination among healthcare entities. It also was created to include healthcare system preparedness entities, public health preparedness officials, and emergency managers.

In addition to the Emergency Preparedness Rule, the U.S. Department for Health & Human Services (HSS) has run a Hospital Preparedness Program since 2003 with the objective of better preparing public health systems for “medical surge events” so they can respond more effectively. The HHS provides grants and funding for participating healthcare entities that participate in the program. In the financial year ended 2018, HHS paid more than $225 million to participating healthcare entities.

Core Elements of the Emergency Preparedness Rule

Risk Assessment and Planning

There are four core elements of the Emergency Preparedness Rule, the first of which is “Risk Assessment and Planning”. This element requires all healthcare entities to develop an emergency plan based on a risk assessment and using an “all hazards” approach. The emergency plan must focus on capacities and capabilities, and be updated annually.

Policies and Procedures

Based on the emergency plan, policies and procedures must be developed and implemented that - in Critical Access Hospitals and Long Term Care facilities - include the provision of subsistence needs for staff and patients whether they evacuate or shelter in place. The policies and procedures also need to be reviewed annually even if no changes are made to the emergency plan.

Communication Plan

A communication plan must be developed that specifically addresses communication and coordination with local, state, and federal officials, patients, and patients’ family. The healthcare emergency alert system implemented to execute the communications plan must be capable of alerting large numbers of people to an emergency in the shortest possible time, and communicating the nature of the emergency.

Training and Testing

Covered healthcare entities must also develop and maintain training and testing programs, including training in policies and procedures. Staff will have to demonstrate knowledge of emergency procedures and be provided with training at least annually. Facilities must conduct drills and exercises to test the emergency plan or participate in an actual incident that tests the plan.

Integrating a Communication Plan with a Hospital Preparedness Program

In terms of complying with the communications plan requirement of the Emergency Preparedness Rule, the healthcare emergency alert system implemented to execute the plan must be capable of facilitating two-way communications between key personnel over multiple channels of communication. There is a similar requirement in HHS´ Hospital Preparedness Program, in the context of providing situational awareness to incident managers in order to assist with decision making and resource allocation:

“The State and healthcare organizations, in coordination with Healthcare Coalitions, relevant response partners, and stakeholders, [must] have or have access to redundant, interoperable communications systems. These systems must be capable of communicating vertically with local, state, and Federal incident management and Emergency Support Function (ESF) #8, and horizontally with critical healthcare response partners in the community.”

In this respect, it makes sense to use the same solution to comply with the two sets of requirements. A multi-model healthcare emergency alert system that can communicate the risk of danger to staff and patients - and that can act as a command center during an emergency - saves time, save lives, and enhances coordination. Integrating an on-call staffing module into a healthcare emergency alert system with geo-polling capabilities can provide further benefits to healthcare entities, staff, and patients.

What is a Healthcare Emergency Alert System with Geo-Polling Capabilities?

A healthcare emergency alert system with geo-polling capabilities is a system that - as well as performing the functions mentioned above - enables administrators to send polls to groups of employees. The polls are typically simple questions followed by a small selection of answers. For example, if the system is being used as an on-call staffing module, the question could be “Are you available to work tonight?” The selection of answers would only have to be “Yes” or “No”.

In the event of an emergency, the poll would more likely read “Medical Surge Event. Please advise ETA” with a selection of times as the required answers. The responses would help with planning the response to a medical surge event, and could be sent to different groups of medical personnel in stages in order to better manage arrival times (i.e. ER personnel > surgical personnel > recovery personnel). This feature can be an important benefit when applying for accreditation with the Hospital Preparedness Program.

The “geo” element of the geo-polling feature is of benefit when an emergency has struck a medical center and administrators need to check on the wellbeing of their employees. A general poll can be sent to all employees asking “Are You Alright” with the selection of answers being “Yes”, “No - I need medical help” or “No - I need help escaping”. When responses to the poll are received, administrators also receive details of the employees´ locations so they can direct help where it is required.

Similarly, the geo-poll feature can be used to check on the wellbeing of medical personnel working alone in the community. The lack of a response would alert administrators to a potential problem and procedures could be initiated to locate the non-responsive member of staff - such as using the geo-poll feature to find out who is closest to the non-responsive member of the staff at their last known location.

In May of 2018, the Hospital Preparedness Program celebrated fifteen years of enhancing the ability of hospitals and healthcare systems to prepare for and respond to public health emergencies. We look at why the program was established, what its objectives are, and where it may be headed in the future.

Prior to the tragic events of 9/11, disaster preparedness rarely focused on healthcare issues. Due to an increase in international terrorism, the majority of efforts focused on repairing infrastructure and meeting the food, shelter and economic needs of displaced persons. Indeed, prior to 2001, the Emergency Preparedness Standards for Hospitals issued by the Joint Commission on Accreditation of Healthcare Organizations primarily concerned bomb threats, floods, and loss of utilities.

The attacks on the World Trade Center and Pentagon highlighted how unprepared the healthcare system was for mass casualty terrorism. When hospitals in New York City and Washington D.C. initiated their disaster response plans, they found they were not adequately prepared for the magnitude of the events. Both hospitals experienced problems with communication, patient tracking, data management, staff support, personnel identification, and overcrowding.

A further terrorist event in 2011 - the mailing of envelopes filled with Bacillus anthracis (the bacterium that causes Anthrax) to media offices and U.S. Senate offices - revealed a different level of fragility in hospital preparedness. Emergency response personnel were asked to investigate countless incidents of “suspicious powder”, but, at the time, few healthcare professionals were familiar with identifying symptoms of the bacterial disease, treating it, or preventing it from spreading.

Federal Response to Shortfalls to Healthcare Preparedness

The lack of fully effective responses to 9/11 and the Anthrax attack prompted the federal government to pass the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. This Act built upon existing programs to establish a National Bioterrorism Hospital Preparedness Program. The initial objectives of the program were for the better preparation of healthcare systems to respond to bioterror attacks and other public health emergencies such as flu pandemics and natural disasters.

In order to help meet the objectives, in 2003 the Health Resources and Services Administration (HRSA) made $498 million available in funding for the development and implementation of cooperative agreements which would improve collaboration between healthcare systems. In order to be eligible for a Hospital Preparedness Program grant, healthcare entities would have to use the funds to complement their existing preparedness programs in the areas of:

• Improving bed and personnel surge capacity.
• Increasing decontamination and isolation capabilities.
• Strengthening interoperable communication systems.
• Bed tracking and personnel management.
• Hospital evacuation planning.
• Fatality management planning.
• Emergency training, education, drills and exercises.

However, in the aftermath of Hurricane Katrina in 2005, it became evident grants had been used to fund individual hospital preparedness programs, rather than develop regional cooperative agreements. Congress responded by transferring responsibility for the Hospital Preparedness Program to the Office of the Assistant Secretary for Preparedness and Response (ASPR) - tasking the department with developing Healthcare Coalitions for better information sharing and response coordination.

How the Program has Developed Since 2005

Since 2005, Healthcare Coalitions have developed from being relatively small cooperative agreements to multi-agency organizations that not only count healthcare facilities among its members but also local, state and federal jurisdictional authorities. There are now 470 Healthcare Coalitions around the country comprised of over 31,000 members. During the past fifteen years, the Hospital Preparedness Program has overseen an investment of nearly $6 billion in the nation's healthcare system.

The investment has been effective in changing the way healthcare is delivered during public health emergencies. Whereas prior to 2005, competing hospitals were reluctant to share information, issues existed about liability exposure, and few healthcare entities collaborated with emergency management or public health, there are now many examples of how Healthcare Coalitions have mitigated the impact of public health emergencies to ensure the best possible outcome for the greatest number of patients.

The 2009 H1N1 “Swine Flu” Pandemic

Although the 2009 H1N1 “Swine Flu” pandemic claimed more than ten thousand lives, the outcome could have been much worse had it not been for collaboration between multiple agencies to rapidly distribute anti-virus vaccines, and to test, diagnose, and treat an estimated 57 million Americans who contracted the disease.

Hurricane Sandy in 2012

Hurricane Sandy in 2012 proved to be the first major test of public-private coordination since Hurricane Katrina. Under the Hospital Preparedness Program, patients from twelve evacuated hospitals and other healthcare facilities in New York State were successfully relocated, and more than two thousand healthcare professionals were brought in from other jurisdictions.

The 2013 Boston Marathon Bombing

Within minutes of two explosive devices being detonated near the finish line of the 2013 Boston marathon, the city's hospitals went into emergency response mode. It has been calculated that - due to the Hospital Preparedness Program, training, drills, and coordination between healthcare facilities - more than 140 lives were saved.

The U.S. Ebola Outbreak that Never Happened

It is not known how many lives were claimed worldwide by the Ebola outbreak of 2013-2016 due to massive underreporting. However, in the United States, thanks to a coordinated effort to test, isolate, and treat hundreds of people potentially at risk from the highly-contagious and life-threatening virus, there was only one fatality.

Ongoing Issues and Where the Program May Be Headed

Current ASPR guidance requires hospitals in the Hospital Preparedness Program to have redundant and reliable emergency communication systems. Most healthcare facilities have improved their communication capabilities, but issues exist with the modes of communication used and how they might be impacted by a natural disaster or infrastructure damage.

Furthermore, whereas some states and municipalities have developed healthcare-specific emergency operations centers (HEOCs), there are issues about how these EOCs communicate with each other. Without compatible systems being deployed, the risk exists command and control functions will become isolated and dysfunctional during an emergency event that is rapidly expanding in scale and impact.

These issues need to be resolved before plans to create a coordinated national disaster health response system can be realized. The coordinated national system would not only be used in times of emergencies, but also to resolve the current healthcare crisis which sees 50 percent of emergency departments operating at over capacity, and 500,000 ambulances diverted each year from the nearest hospital due to emergency department overcrowding.

What has been achieved in the fifteen years of the Hospital Preparedness Program is certainly worth celebrating, but there is still a long way to go.

Determining when a panic button is required depends on two different factors. A panic button might be required by law or it might be provided for ethical reasons even when it is not mandated by legislature.

There has been a lot of media attention given to panic buttons recently; the tragic school shooting in Parkland, Florida, in February raised the issue of school safety, but the topic has also come up in reference to workers in the hotel industry campaigning for greater protection against sexual harassment. However, campaigns in favor of panic button legislation have been ongoing for many years - some successfully, others not so successfully. Of course, a community does not need a legal mandate to consider leveraging this technology for safety purposes. There are several ways this tool can be implemented, and both prove it's necessity. 

The taxi industry is a prime example of the law requiring the use of a panic button. In New York City, legislation was passed in 1994 requiring leased yellow cabs to be fitted with “trouble lights” following a spate of murders and assaults on taxi drivers. Campaigns to install panic buttons in the rear of taxis to protect passengers from assault by taxi drivers were not as successful in New York City; but, in Washington DC, a similar campaign found success in 2012, and panic buttons for both drivers and passengers are now a licensing requirement.

In other areas of the transportation industry, panic buttons have been a regular feature on buses and school buses since the Department of Transportation found GPS-enabled panic buttons improved emergency response times by 18 minutes and off-route detection by more than 3 hours. There is no mandate for state and local governments or school districts to install GPS-enabled panic buttons on their buses. Many choose to do so to enhance the safety of bus drivers and their passengers. There's also the question of ride-share technology - Uber recently installed a panic button feature in the app, responding to assault reports by drivers. 

Little Done to Support Healthcare Workers

The discussion about panic buttons in the transportation industry is of particular relevant to lone workers, but these legal conversations fail to address the dangerous situations workers face on a daily basis in the healthcare industry. Despite healthcare and social assistance employees making up only 12.2 percent of the working population, nearly 75 percent of workplace assaults occur in the healthcare sector. A study in 2017 found the majority of physical attacks are instigated by patients (64 percent), followed by families (30 percent).

However, little has been done to provide healthcare workers with access to panic alarms either in brick-and-mortar medical environments or in the community. This may have to do with certain solutions that have been suggested in law are impractical (fixed panic buttons at nursing stations) or because they too complicated - for example a “Code Blue” paging system that has a different code for every type of emergency and every location. It's too difficult to remember the right code to use in a stressful situation, especially when the hospital and healthcare facility already operates on a safety system that differs from other public and private locations. 

Panic alarm pendants have also been suggested as a solution, but these have their limitations. Pendants only work within range of a base console and so are impractical for medical professionals moving between departments and community nurses working in the field. Furthermore, should an incident occur in which a medical professional requires urgent assistance, the location communicated to security personnel will be that of the base console. The incident could be taking place up to 200 yards away. This also fails to address the fact that many physical panic buttons contact an alarm company first and foremost, which does little to help a healthcare employee working in a high-stress environment. A medical emergency can turn in seconds, and the time to reroute the lack means these panic buttons are impractical for this environment. 

Schools and Hotels Determine Need On A Case by Case Basis

With regards to panic buttons for schools, legislation at state and local level is at various stages of consideration. Only the state of Arkansas has passed legislation mandating panic buttons in schools, while the states of New York and New Jersey are relying on the passage of ballot measures in this year´s elections to provide the finance for statewide panic buttons. At the local level, several school districts have themselves funded panic buttons, rather than wait for state and local governments to provide funding. Hopefully, grants for this technology will help local communities implement a panic button in schools, libraries, and other public spaces. 

Panic buttons for certain hotel workers is also in the consideration phase. Since 2012, workers belonging to the New York Hotel Trades Council union have been provided with panic buttons when they have to work alone in guest rooms. The states of Washington DC and Seattle followed suit in 2016; and this year Chicago passed an ordinance requiring a panic button system was implemented in all the city's hotels for lone workers.

Union discussions are underway with hotels in Las Vegas - where the Marriot and Hyatt hotel chains provide their staff with personal distress alarms voluntarily - and also in resorts situated in Miami Beach Florida and Long Beach California. Union groups hope to get support for panic button ordinances this year, although it is not yet known whether the ordinances will protect all employees or just unionized employees who work alone as in New York.

Where the Discussion on Panic Buttons is Headed

Regardless of whether legislation is passed or not, the discussion on panic buttons seems to be focusing not so much on whether panic button systems should be installed (most parties believe they are a good idea in emergency scenarios), but what type of panic button systems should be installed. Fixed panic buttons systems are impractical in many emergency scenarios, as are wearable panic button systems for the reasons given above. The discussion is headed towards panic button apps, which offer a modern alternative. 

GPS-enabled panic button apps are simple to download and operate, and inform emergency services or security personnel about the nature of the emergency and the location of the emergency with a tap of a smartphone screen. The apps were chosen by the state of Arkansas to protect all K-12 students in the state, and may soon be seen throughout New York's schools after the state's Education Task Force recommended against fixed panic button systems.

GPS-enabled personal safety app systems would also be idea for lone workers - especially medical professionals working in the community - as they would help any employee facing dangerous situations on a daily basis in the industry. Furthermore, GPS-enabled panic button app systems prove to be effective in emergency scenarios, they do not have the hardware costs associated with fixed and wearable panic buttons systems and save time by connecting directly with local first responders instead of routing the call through an alarm company.

A recent focus has been put on how immigration raids impact workplace safety. While not new, the issue was thrusted into the spotlight after an incident in March of 2018 when federal immigration agents surrounded a meatpacking facility in East Tennessee. The confrontation would be the largest single workplace raid in over a decade with over 97 undocumented workers arrested and taken into custody, removing many from their families. 

The incident is just one in a growing number of ICE raids in workplace settings, and these incidents have consequences for employers managing workplace safety. The fear of deportation discourages employees from reporting important information while on the job, and potentially jeopardizes workplace safety.

The Trump Administration has a "zero-tolerance" policy on immigration and kept a campaign promise to ramp up workplace raids. According to the Washington Post, acting ICE director Tom Homan ordered the number of work-site inspections and operation disruptions to increase by four or five times in 2018. The administration intends to target industries that draw people who are in the country without documentation, and to punish the employers who hire these people. The number of immigration-related arrests have increased overall, and is up over 40% since Donald Trump took office. In January, ICE officials targeted 7/11 stores across the United States as well, with agents showing up at over 98 locations and making 21 arrests.

Immigration raids have the potential to create an adverse effect on workplace safety. These targeted investigations, which were more common during the George W. Bush administration, can instill fear in a workplace, but also throughout the entire community. In Tennessee, the raid on the meat processing plant sent waves through the small town. “People are panicked,” Stephanie Teatro, a co-executive for a local Immigration Rights Organization, told the Washington Post. “People are terrified to drive. People are terrified to leave their homes.” In these situations, many immigrants, even if they have citizenship, will want to keep a low profile while at work. 

Fear can stop employees from reporting dangerous events in the workplace, whether it is dysfunctional machinery or harassment from a coworker.  Even if the company, factory, or other workplace doesn’t employ workers with undocumented status, this fear can still have an impact on the workplace. Many new employees are hesitant to report suspicious activity, should it draw attention to themselves. Even people with citizenship status don’t want to put their family members in a compromising position. In Tennessee, only 21 people taken from work at the meat-packing plant were taken to trial and deported, meaning most of the workers were arrested without cause. Nobody wants their family to experience a parent or spouse being incarcerated in a detention center, and these arrests can be traumatic for individual workers. 

It’s well known that the restaurant, farming, and food processing industries depend on immigrant workers. The reality in these industries is that many of these roles are difficult work and if employers are unable to fill positions with American citizens, they will turn to undocumented workers. This poses a unique challenge for safety, as these are also all fields with high rates of workplace injury and other safety challenges. According to the Population Reference Bureau, foreign workers, including individuals who are documented, make up 15% of the job market in the United States, but account for 18% of all job fatalities. 

The food processing complex poses the biggest physical risks, but immigration fears pose obstacles in other industries as well. The restaurant world in particular has a high rate of workplace violence, with women especially vulnerable to verbal or physical assault while at work. For this reason, employers and business owners should be aware of how ICE raids impact workplace safety and prepare accordingly. There are several ways to improve safety practices amidst the current climate, and by improving communication and leveraging technology every workplace can be kept safe.

How to Encourage Workplace Safety During the ICE-Raid Era

ICE raids can often instill chaos and panic, and the more information employees are given, the less likely these incidents are to negatively impact the workplace culture in the short and long term. Communicate to employees that every worker, even if they are undocumented, has rights in the case of a raid. Many times, ICE officials will use warrants signed internally, to circumvent a court-ordered warrant. If possible, be sure to read the paperwork in its entirety, as ICE needs permission to enter a private property. It’s not a bad idea for employers to read and question a warrant – even if the facility doesn’t have undocumented people working inside, a raid can cause disruptions and instill fear in the community in the long term. Employees should understand that under constitutional law they have the right to remain silent, no matter what their immigrant status. ICE often relies on “informed consent” to arrest workers, and it’s not necessary to give verbal permission.

These practices are all legal and communicating employee rights can help dispel some of the tension and fear around ICE raids. A mass notification system can help a company or institution contact all employees in a timely manner, and workers can even opt to receive information in their language of choice. If employers communicate how a potential ICE raid might impact the workplace, they should be able to address and manage fear. Make sure that employees feel comfortable reporting issues in the workplace, and that it won’t jeopardize their position or the safety of other workers.

Leveraging Technology To Improve Workplace Safety

In many instances, the threat of ICE coming into the workplace can prevent workers from telling higher-up people about technical or interpersonal issues on site. An anonymous two-way tip texting system can help with self-reporting, as workers are able to communicate with managers at the company should an issue arise without worrying for the safety of their family. Many of the employees from immigrant backgrounds had lived in the United States for over a decade, but still faced detainment. Given the size and scope of these interventions, even longtime citizens fear these searches. 

In June, ICE carried out a raid on Fresh Mark, a meatpacking plant in Ohio. The raid was the largest in United States history, with over 100 federal agents surrounding the facility and arresting over 146 employees. According to Bloomberg, the facility was issued 13 citations and a $211,194 fine after an employee was killed by a meat-skinning machine in December. OSHA inspections revealed that the employee got his leg caught in a operating auger at the Canton plant, amputating his leg and killing him. The fine was for Fresh Mark's failure to put the proper guards for the auger, which could have prevented the accident.

Bruce Goldstein, president of the advocacy group Farmworker Justice in Washington, told the publication that there is a direct correlation between and unreported safety hazards. "Many of those workers are too afraid of retaliation to challenge unfair or dangerous illegal conduct," he said. "They’re generally too afraid to go to a government agency to report illegal or dangerous practices by their employers. They’re usually to afraid to even go to a lawyer to help them." So, taking the potential risks that immigration raids pose, it's important to find ways to keep communication between facility managers and employees open. 

"Many workers...are too afraid of retaliation to challenge unfair or dangerous illegal conduct. They’re generally too afraid to go to a government agency to report illegal or dangerous practices by their employers."

For workers, there’s also the issue of wage or hour violations and verbal or physical violence in the workplace. Many people avoid coming forward when these events occur, even before the escalation in immigration enforcement over the past couple years. An anonymous tip-texting system can help manage appropriate workplace practices, across ranks in the company. It can also help address issues of harassment or other inappropriate workplace behavior, since statistics demonstrate that women are afraid to report these behaviors, even in work environments where the looming threat of immigration agents are not a consideration. These raids leave low-wage workers who are women especially vulnerable, and employers must consider ways to this demographic of worker safe, as they are unlikely to report abuse on site unless there is a private medium of communication. 

In recent years, a number of hotels have started issuing wearable panic buttons to employees whose job involves entering a guest room or bathroom alone. However, considering the delays in responding to the Mandalay Bay hotel shooting last fall, should hotels be offering panic buttons to all staff?

In Seattle and Chicago, hotels are required by law to provide panic buttons to employees who work alone. Panic buttons must also be distributed to lone employees in unionized hotels in New York and Las Vegas, and the Marriot Hotel chain is voluntarily working on a pilot project to equip employees who work alone with “personal distress alarms”. Employees of the Hyatt Hotel chain already have them.

The purpose of equipping housekeepers, engineers and room service staff with panic buttons is to allow them to instantly summon help if they are sexually assaulted or harassed by a guest – a job hazard worker advocates say is more common than most people realize. They can also be used to alert hotel security to a fire or to request medical assistance if an unresponsive hotel guest is discovered in a room.

In Seattle, the first city to pass a hotel panic button law on 2016, housekeepers are reporting they feel safer according to union organizer Abby Lawlor. Lawlor says she is unaware of specific circumstances in which the panic buttons has been used to prevent a sexual assault, although they did prove useful when a group of housekeepers got trapped in an elevator at one Seattle hotel.

The Mandalay Bay Hotel Shooting in October 2017

On October 1st, 2017, gunman Stephen Paddock fired more than a thousand rounds of ammunition from his 32nd floor room in the Mandalay Bay hotel at concertgoers attending the Route 91 Harvest music festival on the Las Vegas Strip. Paddock killed 58 people and injured a further 851 concertgoers during a ten-minute shooting spree, at the end of which he shot and killed himself.

Shortly before the shooting started, a hotel security guard had been sent to the 32nd floor to investigate an open door alert. On hearing the shooting, the security guard went to investigate and was shot in the leg. Both he and a nearby maintenance worker reported the shooting to their superiors and told them to call the police.

It took police officers already at the Mandalay Bay hotel (investigating an unrelated incident) approximately fifteen minutes to respond, and a further fifteen minutes for more officers to arrive at the scene - the delays being attributed to confusion over whether the shots had been fired from the Mandalay Bay hotel, the nearby Luxor hotel, or within the venue where the festival was being held.

Are Panic Buttons for Hotel Staff Enough?

Panic buttons have now been issued to employees at the Mandalay Bay hotel - but these only connect staff to managers in order to notify acts of abuse, assault or harassment. In an emergency, employees would be unable to communicate the nature of the emergency or connect directly with 9-1-1. Effectively, the Mandalay Bay hotel shooting could take place again with the exact same consequences.

A far more appropriate solution would be a mobile panic button app that connects directly to 9-1-1. With two taps of a screen, app users can notify 9-1-1 of an emergency, the nature of the emergency and its location. 9-1-1 dispatchers get details of the individual who has initiated the emergency call, and details of the environment in which the emergency is occurring - such as floor plans, access points and utility shutoffs.

An after-action report was released yesterday on August 27th, 2018 by FEMA, the Clark County Fire Department and Las Vegas Metropolitan Police Department detailing the entire emergency response at the Mandalay Bay hotel. What's made clear is that critical emergency response personnel were not on the same page as the incident unfolded. However, perhaps had the nature of the incident and its location had been immediately relayed to 9-1-1 dispatchers, coordination with other parties onsite and those responding to the incident could have been better orchestrated and the confusion that led to the delayed response could have been averted. 

While the incident that occurred at the Mandalay Bay Route 91 harvest music festival is at a larger scale, it showcases the need for better communication between hotel staff and security to enhance emergency preparedness.

Most people will have been exposed to SMS opt-in, as it is commonly-used in text message marketing. Not as many people will be aware that an SMS opt-in/opt-out option also exists on most mass emergency notification systems, and that this feature can be a valuable asset in many different use case scenarios.

You have undoubtedly seen them. They appear on the sides of buses, outside houses for sale, on chalkboards outside restaurants, and inside practically every magazine. They are ads inviting you to text a keyword (i.e. “pizzas”) to a short code number (i.e. “749927”) in order for you to get a discount on your next order, get further information about a product or service, or to donate to a good cause. 

When you text the keyword to the short code number, you are then invited to opt-in to the text message marketing service. Usually there is a good reason for doing so such as future discounts or further information. If you choose to opt-in, you will then receive an SMS text notification whenever there is a relevant promotion or information available you have indicated an interest in.

There are probably many more uses of SMS opt-in services than you think. Churches, political parties and schools take advantage of text messages to build connections with parishioners, voters, and parents. Employers operate SMS opt-in services to advise job seekers of vacancies, while a number of sports team also offer SMS opt-in services to keep fans up-to-date with scores on game day.

SMS Opt-In for Mass Emergency Notification Systems

Mass emergency notification services populate their databases in different ways. Systems used by employers and educational institutions are typically populated by uploading an existing database of employees or students into the mass, while city and local governments usually invite businesses and residents to register for emergency notifications via a web portal or by SMS opt-in.

Of the two registration methods, SMS opt-in is the most effective. Not everybody has a smartphone they can use to visit a web portal immediately, and they may well forget to register by the time they can access an Internet-connected device. By comparison, people tend to act immediately when they see a text message marketing ad for fear of forgetting the keyword or short code number.

The SMS opt-in method is also ideal for temporary visitors such as tourists, concert-goers, and conference delegates. Temporary visitors follow the same opt-in method as permanent residents and, as soon as they leave the area and no longer have a need for emergency notifications, they simply text “stop” to the short code number to be removed from the emergency database.

How NYU Simplifies the SMS Opt-In/Opt-Out Process

A good alternative to the opt-in/opt-out process for temporary visitors is used at New York University (NYU). The university populates its mass emergency notification database automatically as students start their academic careers, but also gives temporary visitors the opportunity to enroll in NYU Alert via the SMS opt-in method. For example:

• Visitors wishing to enroll for 24 hours text “NYUALERT1” to 67283
• Visitors wishing to enroll for one week text “NYUALERT7” to 67283
• Visitors wishing to enroll for six months text “NYUCOMMUNITY” to 67283

As soon as the selected time period expires, temporary visitors are sent a reminder with instructions on how to re-enroll. If visitors fail to re-enroll, their information is removed from NYU´s emergency notification database. It is a very simple process and it enhances the safety of anyone participating in an NYU-Sponsored program - including visitors to campus, program participants and their parents. These extra safety steps can play a large role in the college or university students choose to attend. 

Other Ways in which SMS Opt-In Systems can be Used

Although NYU only gives temporary visitors three options for enrolling in the university´s mass notification system, the actual number of options available is almost infinite. Organizations with an SMS opt-in system that uses a dedicated short code number can generate countless keywords and sub-keywords in many use-case scenarios - both emergency and non-emergency.

There are many benefits to this capability. By using different keywords, organizations can create different categories within their emergency databases according to location, role, or other attribute. When an event occurs that only affects one category (for example a fire in an isolated building of a university campus), emergency notifications can be sent to only those for whom the alert is relevant.

There are no limits to how many keywords businesses, universities, and state and local governments can generate, or how many categories they can create. Therefore, in theory, it would be possible for residents wanting to be informed of traffic delays (the category), to receive information relevant to their location (a sub-category), in Spanish or any other available language (sub-categories of a sub-category).

Find Out More about SMS Opt-In Emergency Notification Systems

In 2016, two backpacking Argentinians were brutally assaulted and murdered after accepting an offer to stay at the home of two men in Ecuador. The girls had run out of money, and were attacked after refusing the advances of the two men whose home they had decided to stay in. The incident raised new questions about safe travel and caused an uproar in support for women traveling alone. 

People on the internet and across the world were quick to place blame on the women for traveling without a man to protect them. Women rose against the sentiment, saying the two should not be faulted for their deaths—rather it should be on the men who killed them. There were many passionate defenses of solo travel, and a hashtag #viajosola meaning "I travel alone" went viral. According to CNN, the hashtag was picked up by hundreds of women sharing stories of travel and defending the right to see the world without discrimination or harassment. 

For many women, traveling alone is a necessity. Women should be able to vacation solo without concern of harassment or assault, but they also must be able to travel safely for their jobs. The same concerns about solo travel apply to business trips, and it is not just women who travel for fun facing more risks today. According to Forbes, nearly 70% of travel buyers (people who arrange employee travels within a company) agree that female business travelers face higher risks than men. The percentage of women traveling for work is rising as are the number of situations that can compromise their safety. 

Leveraging Technology to Support Women Working Abroad

Travel buyers are a great resource to have in an office of traveling employees. Having a person who knows the employees schedule and booking information in case of an emergency can be vital. It's important that all employees working out in the field receive support from the company's upper management. Women should feel they have an open and understanding line of communication with the business should an emergency happen. 

The Global Business Travel Association’s (GBTA) recent study shows that women have more concerns over traveling to certain countries/cities, as well as with sexual harassment and assault or kidnapping. Awareness about the global risks women in the workforce face while traveling is at an all time high, but little action has been taken. Unfortunately, only 18% of corporate travel policies specifically address the concerns and safety needs of women business travelers. 

Women have always been a target for predators, but is there a way your company could bolster travel safety practices and increase security for women have while traveling? Keeping all traveling employees safe can be a difficult task. It’s essential for a company to have good communication with their employee as they travel, yet only 43% of business travel buyers have the ability to communicate with travelers at all times, rating their communication ability 7 or under on a 10-point scale (Forbes). This is a simple way to increase employee safety and lessen fears women might have traveling, making a new communication system a worthy investment. 

Not only is having the right means of communication important, but also making sure messages are getting through to a traveling employee can be tricky. 39% of employees prefer to communicate through text messages, yet only 17% are currently notified through SMS messages according to a recent workplace safety survey. This demonstrates the need for an updated emergency notification system with the ability to communicate across mobile platforms. 

The right software to communicate is just one way that technology can be leveraged to help women traveling for work. Alert or mass notification systems that can reach all employees—even those traveling—can keep everyone informed of developing situations. This can help keep employees out of the office informed of developing emergency situation on site so they can plan accordingly. 52% of traveling employees would like to get emergency communications via text messages while offsite, according to the Rave Workplace Safety Survey.

Hotel Safety & Other Best Practices For Traveling

Women are better known for replying to messages concerning their safety, but there are other precautions that travel buyers can take to lower the risk women face while traveling. The GBTA recommends that female travelers be booked into rooms on the third or higher floors of hotels, limiting the access others have from getting into the room. (Having 24-hour security guards at the hotel would be an added precaution as well.) However, USA Today reminds travel buyers to be aware that most fire emergency vehicle ladders don’t always reach past to the eighth floor.

Also, being aware and not saying your hotel room number out loud is a simple tip that could be lifesaving. Other small things that could impact travelers could be as easy as requesting two room keys to make it appear as if you aren’t raveling alone and not using room service cards to order food as that could point to you be alone in the room. Call down to room service instead to avoid giving away information.

Surprisingly, three out of five (61%) of travel buyers “rarely” or “never” provide chauffeured transportation to female travelers (GBTA). This is a missed opportunity, as this is a simple way to support employees who might be vulnerable while traveling. Registered chauffers for ground transportation, especially in foreign countries is a must, the GBTA says.  Knowing travel routes in advance can also put women travelers at ease. Always reconfirm that the transportation you’ll be taking is on time, as that will cut down on stress for the traveling employee (Women on Business).

While there are additional risks for women traveling for business, this should not stop employees from having equal opportunity. There are several simple steps that companies and businesses can take to ensure women are safe while they are out of office, whether it is leveraging technology to improve employee communications or establishing best practices for safety.

Having strong corporate communications can help your business weather just about any storm. Most of us know how important it is to have great public relations and manage our marketing messages, but it’s also essential to be communicating well with employees and improving internal communications during a crisis.

Internal communications are too often overlooked. Of course, when a crisis hits, people often start thinking about internal communications and how to keep everyone calm and informed. Unfortunately, by then it’s often too late to properly form a solid communications strategy or even identify which tools to use for company-wide communications that'll get noticed--it’s much better to be thinking ahead and planning for the inevitable. 

Simply put, is your organization ready to communicate effectively with employees if an active shooter situation happens nearby? Or if a disgruntled employee becomes violent? It’s not easy to think about, but it’s so much better to be safe than sorry. Planning ahead can be hard, but it’s not impossible. You can prepare yourself to communicate more effectively when it really counts. 

With that in mind, here are four books that can help your organization nail the internal communications process and be better prepared. These are great reads for corporate communications departments, HR personnel, or really anyone who wants to communicate more effectively when worst-case scenarios happen in a corporate setting.

Four Books About Improving Internal Communications During A Crisis

1. Sandcastles in the Tide: The Value of Employee Communications in the Context of Change by Jack LeMenager

Having the ability to manage change and deal with a crisis as a company, according to LeMenager, has a lot to do with building effective communications and engagement with employees from the beginning before the crisis hits. Waiting for a crisis to set up the right communications channels and strategies is far too late. This book explains why good internal communications are essential and talks about how your organization can rethink and rebuild how it communicates. For your organization, this may mean looking at how effectively your communications channels actually engage employees.

As you read LeMenager’s book, it may be helpful to ask yourself how well your company is actually using employee communications. Are you ready for a crisis? LeMenager will tell you that the only constant at your organization is change, whether or not you see it. Rethinking your communications strategy is a worthwhile goal; Sandcastles in the Tide challenges you to do just that. 

2. Crucial Conversations: Tools For Talking When Stakes Are High by Patterson, Grenny, McMillan and Switzler

Frankly, a lot of people are really bad at having difficult conversations. It’s never more important to have these conversations, though, than when the stakes are really high. Crucial Conversations is about how to talk through those circumstances with clarity, persuasion, and honesty. As a communicator, you need to be prepared for situations where these difficult conversations may not even be possible one-on-one. Corporate communications often necessitate communicating difficult information through media such as newsletters, emails, and conference calls.

Even when communication is more impersonal, it takes a serious mindset shift for many of us to be able to handle high-stakes communications in an emergency. Even seasoned professionals can encounter situations where emotions run high and interfere with effective communications. Read Crucial Conversations for insights on how to communicate those difficult messages, stay on topic, and persuade when it’s even more critical than ever.  

3. Sync or Swim: A Fable About Workplace Communication and Coming Together in a Crisis by Chapman, White, and Myra

This book is a workplace communications story that may just inspire you to action and help you start thinking about how your team will lead employees through the next emergency. Written as an enjoyable fable about a sheepdog CEO and his company’s encounter with a coming storm, Sync or Swim was written to get you thinking about the kind of communications you need to use and the mindset communicators need when a serious crisis hits. Will you respond to the storm the way Sam the sheepdog does? Don’t let your company be swept away. 

4. Avoiding Disaster: How to Keep Your Business Going When Disaster Strikes by John Laye

Unfortunately, many businesses simply aren't prepared for natural disasters and stand to lose a lot if one were to actually happen. Natural disasters are inevitable and no human being has control over them, so it just makes sense to have contingency plans and communication strategies in place before the worst happens. 

In Avoiding Disaster, Laye walks managers through strategies that can help them stay ahead of possible disasters and protect their businesses if the worst should occur. He also includes information you can use during the disaster itself, so you have a practical guide to help in the midst of chaos. The book covers natural disasters, but it also has information on preparing for man-made disaster scenarios, too. 

Improve Your Workplace Critical Communication

These four books are all great resources for thinking about critical communications at your workplace. If you want to dig deeper, though, it’s also important to look at how to help employees tune-in better to critical communications by examining the data on how prepared workplaces really are for the inevitable. 

Our whitepaper, Workplace Safety and Preparedness: Survey of Full-Time Employees from Industries across the U.S., offers insights to help you improve workplace critical communications and emergency preparedness. Get your copy to discover which modes of communication today’s employees prefer and learn which emergency plans lack the most awareness. 

Most safety professionals acknowledge it is extremely difficult to find accurate mobile workforce safety statistics. This is often due to factors such as underreporting, the black market economy, and insurance fraud; and complicated by the confusion of employees who work from home included in some definitions of mobile workers.

The consequence of inaccurate mobile workforce safety statistics is that nobody knows the scale of the problem; although, some studies can give some insights into localized or industry-specific issues. This results in mobile workers in genuinely unsafe environments not being given the training nor the tools required to protect themselves in times of emergency.

The Difficulty in Compiling Accurate Mobile Workforce Safety Statistics

As well as the factors mentioned above (underreporting, black market activity, insurance fraud, etc.), the criteria for mobile workforce safety statistics can make a difference to their outcomes. For example, the latest Global Reporting Standards for Occupational Health and Safety (PDF) stipulates that not only are direct employees of an organization considered “workers”, but also individuals who are not employees, but whose work or workplace is controlled by the organization (i.e. volunteers).

What constitutes a mobile workforce also creates issues. In the 2007 study “Understanding and Managing the Mobile Workforce” (PDF), Cisco noted five categories of mobile workers:

• On-site movers - employees who work at one site, but move around within it, e.g. security personnel and IT technicians.
• Yo-Yos - employees who occasionally work away from a fixed location, e.g. in jobs which require business trips.
• Pendulums - employees who alternate between working at two fixed locations, e.g. the employer’s office and a client’s office or a home office.
• Nomads - employees who work in a number of different places and are constantly moving amongst them, e.g. a sales agents, engineers, etc.
• Carriers - employees who work on the move, transporting goods or people, e.g. train conductors or airplane stewards.

Importantly, Cisco defined mobile workers as “those who work at least ten hours per week away from home and from their main place of work, e.g. on business trips, in the field, travelling or on customers’ premises, and use online computer connections when doing so”. The important section of this definition in respect of mobile workforce safety statistics is “work at least ten hours per week away from home”, which implies telecommuters who work exclusively at home should be excluded from statistics.

Safety Data for Mobile Workforce is Also Difficult to Compile

Another difficulty in compiling accurate mobile workforce safety statistics is what constitutes as a work-related injury or illness. The Global Reporting Standards for Occupational Health and Safety are based on OSHA's general recording criteria for occupational injuries and illnesses, which are exceptionally vague about mental health illnesses - a particular issue among mobile workers who face additional stress factors unique to the nature of their work.

Mobile workers miss out on a number of factors that benefit mental health in the workplace such as colleague interaction, peer support and office provisions. Mobile workers in isolated locations can go the whole day without interacting with anyone, while long-distance travelers experience severance from home and family as well as a perception of heightened travel and security risk.

The Consequence of a Mobile Workforce with Poor Mental Health

Whereas the benefits of mobile working are generally acknowledged to be increased creativity and productivity, the consequence of a mobile workforce with poor mental health is that these benefits are reversed. An article published at Inc.com found that 81 percent of workers with mental health issues continue working rather than taking time off to seek treatment. Based on the author's calculations, “presenteeism” is costing U.S. companies more than $35 billion each year in lost productivity.

It is not necessarily employers who are to blame for this situation. Throughout history there have always been mobile workforces (Roman armies, seafaring merchants, stagecoach drivers, etc.). However - due to modern technology - the number of mobile workers has exploded in recent years. According to our infographic, 43 percent of the U.S. workforce currently works remotely (mobile workers and telecommuters) and this figure is anticipated to increase to 50 percent by 2020.

The explosion of mobile workforces has accentuated stress factors that were rarely considered before. Some of the stress factors that develop into mental health issues are self-inflicted by mobile workers not cut out for working remotely, but - according to a review of globally published research funded by the British Occupational Health Research Foundation (PDF) - 64 percent of mobile and remote workers were found to have mental health above the level defined as psychological distress.

Solutions to Resolve Poor Mental Health in Mobile Workers

There are a number of solutions available to resolve poor mental health in the general workplace (i.e. Employee Awareness Programs), but not so many to resolve poor mental health in mobile workers. Mental health authorities advocate regular communication with mobile workers, and ensuring that supervisors and managers quickly address any problems they encounter. This may partly resolve the issues of colleague interaction, peer support and office provisions, but is not a complete solution.

According to our own research, 26 percent of mobile workers feel that worrying about their safety affects their work. One solution that can resolve these concerns is a multimodal communication system that not only warns employees to the risk of danger, but which can also be used for two-way geo-traceable communications, anonymous tip texting, and as a content portal for emergency procedures, travel documents and other key resources.

Want to learn more about the mobile workforce and how you can keep them safe? Download this infographic.

No matter where you are, or what you’re working on, when it comes to the data and information that you transfer or access online, nothing is more important than keeping it secure. That's why businesses, employers, and managers alike should educate and prepare their traveling employees with the strategies they can use to keep their physical and digital information safe. 

Resulting from a stolen device, account, or physical record, identity theft is a serious issue that can affect employers, employees, and clients. Therefore, to help ensure your company’s devices and employee data is safe, we’re covering travel security strategies you can share with your employees in advance to their departure.

Working Safer While On-The-Go

Protect your work equipment and always log out: While traveling, it’s imperative to protect your digital devices and data from both physical and digital forms of theft. To avoid physical robbery, always log out and never leave your work equipment unattended or allow others to use it. When not in use, you should store the device safely and avoid disclosing its location. However, as discussed below, digital theft is also used to gain unlawful access to an individual's or company’s online accounts and stored data.

Update devices before you leave: Installing manufacturer-recommended software before departure ensures that the equipment and applications have been downloaded from a trusted network and are operational. Ignoring critical patches and security software updates can make your device and data vulnerable. To avoid issues while traveling, and guarantee your device and security software is always up to date, consider speaking with your I.T. team about enabling automatic updates that are scheduled to install after work hours.

Avoid public WiFi: Public WiFi networks may seem convenient, especially for travelers, however, if you’ve paid for access and/or a password, this can be risky. Although the information they gain may seem like a foreign language to most, for cybercriminals, this traffic and information coming from a monitored network can be extremely valuable when executing acts of identity theft. Therefore, many companies host Virtual Private Networks that allow authorized employees remote login access to their secure internal network and servers. Using a combination of firewall security and data encryption software, a VPN can be an extremely reliable way for companies to transfer and share data while on-the-go. Before departing, ask your I.T. department if the company has a secure network or subscription to a Virtual Private Network (VPN) for traveling employees. 

Secure all physical documents and devices when not in use: Although it seems rudimentary, physical theft like pickpocketing is still a common practice among thieves. In fact, Europe has seen an enormous increase in pickpocketing cases over the past eight years, resulting in seven reported instances every day. Most often, thieves target a tourist's physical goods, including unattended devices, travel documentation, and wallets. So, when it comes to your physical documents, always safely store them when not in use, and avoid sharing or disposing of plane tickets and itineraries until you return. 

Monitor for unauthorized activity and plan for data emergencies: Being prepared for an emergency such as a stolen device, hacked account, or data breach ensures the digital issues in your workplace can be reported and resolved promptly. An emergency response plan is an essential document that all companies should consider establishing. By documenting the most common digital threats facing your industry, assigning a response team, and providing employees with the information they need to report and respond to a digital emergency adequately, you're preparing your company and employees for even the most unlikely occurrence.

Technology Should be a Priority

It's crucial for companies to prioritize employee safety, even when workers are away from their home base. This poses a variety of challenges for an organization, but by leveraging technology, employee safety can be managed from a distance. Every company has unique concerns and risks, but one issue that should be a priority for  organizations is digital privacy. It's never too soon to put together a company safety plan, and digital breaches can be accounted for along with a variety of other emergency situations. It's important to incorporate traveling employees into these plans, as employers still have a responsibility to keep off-campus employees involved in their emergency practices. 

While there are many physical risks to consider when managing employee safety, employee digital data breaches are increasingly of concern. Preparing employees to manage their privacy while away from the office will improve security for both the individual and the company, and workers will likely be eager to do so. Many people are aware and concerned about issues of data privacy, as it has been in the news often these days. Individuals are likely informed of data mining breaches, as social media giants such Facebook were recently criticized for putting inadequate protections on their service. When this revelation broke, other platforms, such as Twitter, updated their privacy protocol to better protect users. The issue of data privacy is likely a concern for individual employees, so be sure to communicate threats to look out for and best practices for preventing them to your entire team. 

According to the National Privacy Commission, threats to security include  viruses and worms, Trojan horse viruses, phishing and pharmware, adware, spyware, and ransomware. Familiarizing employees with these threats will help prevent a security breach or attack, and improve overall safety. This can be done via an emergency notification system, which can also keep the team updated on any potential breaches of security. For example, if a virus or phishing scam is being circulated via e-mail, this would be a simple way to quickly inform your team what the message looks like and not to open the scam on their computers. This way, even if employees are abroad, they understand the risks and know the protocol for keeping their work data safe.

Security Begins In The Office

Businesses should bolster their data security on-site as well. Managing physical and digital data on-site is crucial for putting together a comprehensive safety plan, and will ultimately help employees who are traveling work better as well. Here are a few ways that businesses and business owners can improve their own security, bolstering the overall safety for their workers: 

• Manage a Secure Database  - To keep track of employee information, it's important to manage a database of information for each employee currently working for your business. However, this information can be sensitive, so finding a way to securely manage employee information is a helpful way to communicate with your entire team faster, as an emergency notification system can notify an entire database about risks for danger, or messages can be sent to a select group, such as employees working off-site or traveling, about potential risks.  
• Prioritize Education & Vigilance - Even with safeguards in place, it's important for companies to have an informed traveling workforce. Many employees, while aware and concerned about data privacy and security, might not be aware of the warning signs or risks. Provide training for employees, or communicate helpful tips for managing privacy while out of the office. 

Business owners can encourage a secure traveling workforce with proper communication protocol in place. Keep your team informed of the risks, as well as best practices for managing security while on the road. Make sure that all team members have opted-in to all emergency and critical communications or alerts, and that they have a way to be in contact with the on-site team at well should any security based issues arise. Keeping employees educated and vigilant about cyber security risks is one of the key ways to build a first line of defense against any potential threat or breach. 

Managing worker safety is essential, even when these employees are traveling or working off-site. There are a variety of tools that can be leveraged to manage both the security and safety of traveling employees. It's important for businesses to account for a variety of potential situations, whether they are off-site on a business trip or there is a weather. It's keep to keep employees looped in during any emergency situation, even if they are away from the office. An emergency notification system is a secure way to ensure the entire team is receiving company updates, even while away from the campus. If there is an emergency situation, whether it is a physical or digital issue, these employees will understand the risks. In the case of a severe weather emergency or other natural disaster, companies can even use this system to perform employee wellness checks for those workers who are out of office. 

Employees can also be empowered to take safety into their own hands with a 2-way anonymous tip texting system. This way, if an employee notices anything suspicious while traveling, they will be able to report the incident back to the business in a quick and effective way. This can even help manage data privacy, as if an employee is worried that their data might not be secure or suspects a phishing scam, they have a fast way to report back to the company and check in on the matter. 

The Internet is full of information about mass notification systems and the specifications they should comply to, but trying to find guidance on when mass notification is required - i.e. when mass notification systems should be activated - is difficult. So, when is mass notification required?

Mass notification systems date back to the Middle Ages, when church bells summoned people to worship. Church bells were subsequently used to warn local populations of impending attacks until they were replaced by sirens in the early 1900s. During the Second World War and Cold War, the use of mass notification systems increased dramatically, and they now play an important role in warning populations of adverse weather conditions, man-made disasters and other emergency incidents.

Federal Guidance on when Mass Notification is Required

Despite their importance, federal guidance on when mass notification systems should be used is hard to find - the exception being the Clery Act, which requires colleges and universities benefiting from federal financial aid programs to provide “timely warnings” of certain crimes. Even then, there is a certain amount of leeway in how and when the warnings are issued, how the person(s) responsible for issuing the warnings interprets the facts, and whether they consider a crime to be ongoing.

Most other federal regulations relate to when systems should be installed (i.e. OSHA 1910.165) or what factors they need to take into account (i.e. Americans with Disabilities Act Title III). Some regulations (i.e. NFPA 72) don´t actually mandate the installation of a mass notification system, but go into immense detail about the specifications such systems should comply with; whereas others (i.e. CMS´ Emergency Preparedness Rule) require an Emergency Action Plan is developed without stipulating how it should be executed.

State and Local Ordinances Fail to Provide an Answer

Most state and local ordinances relating to mass notification also focus on mass notification systems and the circumstances in which they should be installed - relying heavily on the International Building Code or NFPA 5000 Code as their guide. Typically, when a Mass Notification System is required, activation of the system is largely reliant on discretion the operator or subject to an interpretation of the conditions or after carrying out a risk assessment (i.e. see proposals to amend California §8594.6 in SB 833).

Naturally there are some circumstances in which the activation of a mass notification system will be automatic - for example if a heat sensor or smoke alarm detects a fire. But in other circumstances there may be an element of doubt (“is that person carrying a firearm”) and in which hesitation could result in unnecessary death or injury. In these circumstances, organizations should implement “Activate First - Review Later” policies to best protect their communities, employees and students.

The Importance of Having an Integrated Mass Notification System

So far we have established there is little guidance about when mass notification is required and that, to avoid unnecessary delays, it is better for organizations to implement “Activate First - Review Later” policies than to wait and see how a situation develops. There is one other important point to address - the importance of having an integrated mass notification system. This is because according to NFPA 72, a mass notification system should consist of four “layers”:

Layer 1 Immediate and Intrusive Alerting
• One-way voice communication system
• Two-way voice communication system
• Visible notification appliance(s)
• Textual/digital signage and displays

Layer 2 Wide Area
• Wide area outdoor notification system

Layer 3 Distributed Recipient Notification System
• SMS Text / Email
• Computer pop-ups
• Smartphone apps
• Reverse 911

Layer 4 Public Alerting
• Radio & TV broadcasts
• Social Media

It is not necessary for every mass notification system to have every element within each of the four layers, but what is important is that the elements are integrated with each other so they are all “singing the same song”. In a high-rise fire or active shooter scenario, for example, the activation of different elements of a non-integrated system could result in one element sounding an evacuation order, while another element is telling people to stay put.

If your organization is using mass notification for things like severe weather notifications, you should also consider using mass notification to promote workplace safety. 

Almost every employer is required to have an Emergency Action Plan to comply with OSHA's Occupational Safety and Health Standards. Every employer covered by the Emergency Action Plan regulations must install and maintain an alarm system, and train employees to assist in the safe evacuation of others.

However, in a workplace environment, there can be several different types of emergencies that require different responses. For example, the advice given by the Centers for Disease Control and Prevention (CDC) for the appropriate action to take during an earthquake is to stay indoors. An evacuation may also not be the most appropriate course of action during adverse weather or an active shooter event.

So, how can an employer best communicate the nature of an emergency and the appropriate action to take simultaneously to potentially thousands of employees? What if the workplace area is used by temporary visitors (customers, sub-contractors, etc.)? Or an emergency affects one area of a workplace, but not another - for example, the contained release of a hazardous substance?

In these circumstances, the best form of alarm system to use is a mass notification system that has opt-in/opt-out and grouping capabilities. Mass notification systems such as these send the right messages to the right people at the right time - maximizing workplace safety and minimizing workplace disruption. The following explains how these capabilities work and the benefits that can be obtained.

How Mass Notification Systems Work

Mass notification systems work by simultaneously sending administrator-issued emergency alerts to employees and other opted-in system users via multiple channels of communication (SMS text, email, social media, etc.). The system can be integrated with IPAWS for state and federal alerts, and can also be configured to send workplace alerts in multiple languages.

Workplace alerts, instructions how to respond in an emergency, and incident updates can be sent by authorized administrators from any Internet-connected device. It is recommended the text of alerts is prepared in advance to save time when an emergency occurs, and so that instructions on how to respond are clearly defined and not written in a confusing manner due to the stress of a situation.

Opt-In to Receive Workplace Safety Alerts

A workplace mass notification system with opt-in capabilities enables temporary visitors to opt-in to the alert system in the same way they might text a keyword to a short code number to take advantage of a retailer's promotion (for example, text 'PIZZAS' to 749927 to get a discount on your next order). Visitors to the workplace simply opt into the alert system when they arrive, and opt out when they depart.

An alternative to the text opt-in/opt-out process is to provide a portal on the corporate website through which employees and temporary visitors can create profiles indicating their preferred channels of communication for workplace alerts (if not SMS text) and preferred languages.

Minimize Business Disruption with Grouping

When a workplace-wide alarm system is activated, it alerts everybody within the workplace to an emergency incident, regardless of whether they are in danger or not. This can cause significant business disruption when employees who are not at risk follow evacuation procedures and leave their places of work. Mass notification systems with grouping provide a solution to this problem.

Grouping enables employees to be grouped according to their geographical location, role within the business, or other attribute. When an emergency alert is sent, administrators can select only the groups(s) for whom the alert is relevant - notifying only employees who are at risk and minimizing business disruption. This feature can save businesses thousands of dollars in otherwise lost productivity.

Mass Notification Systems with Geo-Polling

A further feature of mass notification systems that can promote workplace safety is the geo-poll feature. This feature is of particular use in widespread emergencies when employers want to check on the well-being of employees. The system is used to send a poll with a simple question (for example “Are you okay?”) and a selection of answers from which to choose:

• Question: Are you okay?
• Response 1: Yes.
• Response 2: No, I need medical help.
• Response 3: No, I need transportation.

The “geo” element of the geo-poll uses GPS to track the location of employees in need of assistance, while the system's reporting function reveals employees who have not responded to the geo-poll. The geo-poll feature used in conjunction with the grouping capability can also be used to assist with business continuity in the event of an emergency as demonstrated in the following case study.

Grouping Capability and Geo-Poll Feature Saves Business $189,000

In 2015, a well-known multi-national consumer goods producer implemented a mass notification system to replace its existing communications system. Prior to implementing the system, a lack of responsiveness had impacted the company's operational capability. Furthermore, the company had no effective means of communicating with remote workers such as drivers.

The following year, a violent storm caused a power outage at one facility. Management used the new mass notification system to notify the next group of employees to delay reporting for their shift and was able to use to solicit availability for extended shifts to ensure business continuity. To find out how this saved the company $189,000, read the case study.

Recap: 4 Ways to Use Mass Notification to Promote Workplace Safety

• Prepare the text of notification alerts in advance to save valuable time.
• Provide an opt-in/opt-out facility for temporary visitors to the workplace.
• Group employees to get the right message to the right people at the right time.
• Use geo-polling to check on the well-being of employees during and after an event.

Mass notification systems do not have to be used exclusively for emergencies. The opt-in and grouping capabilities can be used to advertise social events, job vacancies, and road closures that might affect access to the workplace. System administrators can create an unlimited number of groups and sub-groups, and employees can opt into them and out of them at will, and indicate how they would like to receive each type of non-emergency communication.

Not sure if your current system has enough capabilities to meet you communication needs? Download this checklist.

In The News This Week

This week in industry news, Campus Safety shared that the Police Foundation has initiated a project to study adverted acts of school violence. They have built a national database to collect and analyze data regarding averted incidents to identify best practices to prevent and respond to acts of violence in schools. Key Highlights:

• The project is based on the concept of a "near miss", which has been used to inform the business practices of aviation, fire and medical professionals. These averted incidents contain invaluable information regarding the strengths and or potential weaknesses of current policies, procedures, trainings and methods 
• Based on the preliminary study, in over half of the open source incidents we studied, students were the first to discover another student's plans for school violence
• By submitting and reviewing reports to the Police Foundation, you can improve school safety in your district or on your college campus as well as help other school safety professional across the country improve safety

So far, Police Foundation subject matter experts have reviewed approximately 51 incident reports that been entered into the adverted school violence database. Read the full story here to learn more about these findings. 

This Week From the Rave Team

Read some of the stories our writers were most excited to share with you this week. To access all of our stories, check out our blog. 

4 Ways to Encourage Student Engagement in Campus Safety

Regardless of whether a student downloads an app or not, campus safety officials can still encourage students to safely navigate through campus and provide tips for other scenarios in case of emergencies. A key to success is getting students to take ownership for their well-being and getting involved with campus safety initiatives. Read this blog to learn four ways your campus safety department can encourage students to participate in their own safety. 

                                                                     READ MORE 

Temporary Opt-In for Summer Camp Programs

During the Fall and Spring semesters, a mass notification system is essential for campus-wide communication. However, it can also be a powerful tool for managing safety among summer camp attendees. Regardless of whether a child is there for the day or a whole week overnight, students receiving alerts while they’re in a new environment could help both children and parents in case of emergencies. Read more about the versatility of SMS notifications. 

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Rave in the News

We're excited to be partnering with Santa Fe County's 911 to help local officials keep students and schools safe. The Santa Fe superintendent says the district is always exploring new technology to make schools safer and is excited to learn more about the program and what it can do for schools in the district. 

Major Gabriel Gonzales says the new system can buy emergency response more time and ensure critical incident information is being relayed from the scene to 911 dispatch. Emergency officials hope to get every schools in the county to use it. 

You can read the full story here.